Healthcare Provider Details

I. General information

NPI: 1275100216
Provider Name (Legal Business Name): KELLY CIOCH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY SMOLTZ

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N ROBINSON DR
ROBINSON TX
76706-5303
US

IV. Provider business mailing address

460 OVERLOOK RD
VALLEY MILLS TX
76689-3033
US

V. Phone/Fax

Practice location:
  • Phone: 254-662-3306
  • Fax:
Mailing address:
  • Phone: 734-578-7253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number37209
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: