Healthcare Provider Details

I. General information

NPI: 1083144265
Provider Name (Legal Business Name): KELLY WESSEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY BEGLIN

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4641
  • Fax: 513-636-8283
Mailing address:
  • Phone: 513-636-4641
  • Fax: 513-636-8283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number30.025993
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number9976
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: