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General NPI Number Information
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NPI Number | 1013930445
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Entity Type | Individual
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Provider Name | KELLIE PAXTON D.M.D., M.S.
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Gender | Female
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 11/18/2013
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Provider Practice Location Address
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Address Line | 202 WILLIAMSON RD SUITE 202
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City | MOORESVILLE
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State | NC
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Zip | 28117-7610
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Country | US
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Telephone | 704-799-0110
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Fax |
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Provider Business Mailing Address
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Address Line | 202 WILLIAMSON RD SUITE 202
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City | MOORESVILLE
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State | NC
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Zip | 28117-7610
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Country | US
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Telephone | 704-799-0110
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 9583
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License Number State | NC
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