Healthcare Provider Details

I. General information

NPI: 1881697670
Provider Name (Legal Business Name): KELLY W KREEB DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13210 ROSEDALE HILL AVE
HUNTERSVILLE NC
28078-0327
US

IV. Provider business mailing address

13210 ROSEDALE HILL AVE
HUNTERSVILLE NC
28078-0327
US

V. Phone/Fax

Practice location:
  • Phone: 704-875-7200
  • Fax: 704-875-2964
Mailing address:
  • Phone: 704-875-7200
  • Fax: 704-875-2964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7084
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: