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General NPI Number Information
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NPI Number | 1760840110
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Entity Type | Individual
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Provider Name | KELLY O'SHAUGHNESSY D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 01/31/2016
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Last Update Date | 01/31/2016
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Provider Practice Location Address
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Address Line | 3245 HOSPITAL DR
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City | JUNEAU
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State | AK
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Zip | 99801-7809
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Country | US
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Telephone | 907-463-4050
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Fax |
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Provider Business Mailing Address
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Address Line | 5659 WINTER GARDEN CT
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City | SAINT LOUIS
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State | MO
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Zip | 63129-5905
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Country | US
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Telephone | 314-780-3175
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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 | 2015027487
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License Number State | MO
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