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General NPI Number Information
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NPI Number | 1235764093
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Entity Type | Individual
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Provider Name | KELSEY RO DMD
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Gender | Female
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Dates
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Enumeration Date | 03/11/2020
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 78 NORTHEASTERN BLVD STE 5
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City | NASHUA
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State | NH
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Zip | 03062-3179
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Country | US
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Telephone | 603-883-6546
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Fax |
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Provider Business Mailing Address
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Address Line | 1760 REVERE BEACH PKWY APT 402
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City | EVERETT
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State | MA
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Zip | 02149-5962
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Country | US
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Telephone | 818-395-2477
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 04546
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License Number State | NH
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