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General NPI Number Information
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NPI Number | 1508187626
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Entity Type | Individual
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Provider Name | KELLI ELLEN GRUBBS DDS
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Gender | Female
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Dates
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Enumeration Date | 06/14/2010
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 9775 HWY 64 , SUITE 101
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City | ARLINGTON
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State | TN
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Zip | 38002
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Country | US
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Telephone | 901-235-0709
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Fax | 870-338-3950
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Provider Business Mailing Address
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Address Line | 118 HICKORY HILLS DR
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City | HELENA
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State | AR
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Zip | 72342-2302
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Country | US
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Telephone | 870-338-3961
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Fax | 870-338-3950
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3773
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11199
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License Number State | TN
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