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General NPI Number Information
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NPI Number | 1528594553
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Entity Type | Individual
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Provider Name | KELLIE ROSE SCHWALBACH D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 30 N WALNUT ST
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-3114
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Country | US
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Telephone | 740-497-0894
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Fax |
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Provider Business Mailing Address
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Address Line | 946 CIRCLE DR
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City | CIRCLEVILLE
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State | OH
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Zip | 43113-1418
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Country | US
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Telephone | 740-497-0894
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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 | 30025059
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License Number State | OH
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