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General NPI Number Information
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NPI Number | 1528954286
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Entity Type | Individual
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Provider Name | ALEXIS KELBAUGH DDS
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Gender | Female
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Dates
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Enumeration Date | 06/17/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 33 GAGE DR # 5862
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City | HOLLISTER
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State | MO
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Zip | 65672-5862
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Country | US
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Telephone | 417-334-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 250 LAKEWOOD DR APT 6203
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City | HOLLISTER
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State | MO
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Zip | 65672-5829
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Country | US
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Telephone | 417-527-4869
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2025019815
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License Number State | MO
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