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General NPI Number Information
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NPI Number | 1780306308
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Entity Type | Individual
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Provider Name | KELSEY CONRAD DMD
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Gender | Female
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 1135 VITALITY DR STE 130
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City | HENDERSON
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State | NV
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Zip | 89011-4809
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Country | US
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Telephone | 702-359-7401
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 WIGWAM PKWY UNIT 11209
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City | HENDERSON
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State | NV
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Zip | 89074-8366
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Country | US
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Telephone | 469-274-5826
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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 | 7683
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License Number State | NV
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