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General NPI Number Information
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NPI Number | 1306178249
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Entity Type | Organization
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Legal Business Name | KELLY WEST, DDS COSMETIC & FAMILY DENITSTRY, PC
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 608 E BAILEY BOSWELL RD 100
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City | SAGINAW
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State | TX
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Zip | 76131-3569
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Country | US
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Telephone | 817-234-9378
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Fax |
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Provider Business Mailing Address
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Address Line | 608 E BAILEY BOSWELL RD 100
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City | SAGINAW
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State | TX
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Zip | 76131-3569
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Country | US
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Telephone | 817-234-9378
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. KELLY LYNN WEST
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Credential | DDS
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Telephone | 817-234-9378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 21325
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License Number State | TX
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