Healthcare Provider Details

I. General information

NPI: 1598744377
Provider Name (Legal Business Name): GALEN ARTHUR KELLENBERGER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 INDEPENDENCE SQ
WEST PLAINS MO
65775-4239
US

IV. Provider business mailing address

9650 HWY E
HOUSTON MO
65483-2616
US

V. Phone/Fax

Practice location:
  • Phone: 913-754-6026
  • Fax:
Mailing address:
  • Phone: 913-954-7953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number60334
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2008030992
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD10801
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2021039552
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: