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General NPI Number Information
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NPI Number | 1780205088
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Entity Type | Organization
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Legal Business Name | KELSEY MP HOSTETLER DDS, SC
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Dates
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Enumeration Date | 04/28/2020
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Last Update Date | 04/28/2020
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Provider Practice Location Address
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Address Line | 271 S MAIN ST
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City | VERONA
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State | WI
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Zip | 53593-1470
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Country | US
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Telephone | 608-845-6612
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Fax |
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Provider Business Mailing Address
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Address Line | 6797 HORSESHOE BND
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City | VERONA
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State | WI
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Zip | 53593-9211
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Country | US
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Telephone | 608-448-5056
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. KELSEY MARIE PATTON HOSTETLER
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Credential | DDS
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Telephone | 608-448-5056
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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 |
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License Number State |
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