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General NPI Number Information
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NPI Number | 1891931028
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Entity Type | Organization
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Legal Business Name | R. PAUL KELSON DDS MS ORTHODONTICS PA
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Dates
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Enumeration Date | 12/17/2008
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Last Update Date | 12/17/2008
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Provider Practice Location Address
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Address Line | 10497 GARVERDALE COURT #103
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City | BOISE
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State | ID
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Zip | 83704
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Country | US
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Telephone | 208-378-1300
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Fax | 208-375-3397
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Provider Business Mailing Address
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Address Line | 10497 GARVERDALE COURT #103
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City | BOISE
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State | ID
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Zip | 83704
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Country | US
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Telephone | 208-378-1300
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Fax | 208-375-2795
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Authorized Official
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Title or Position | SECRETARY
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Name | MRS. DIANE C. KELSON
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Credential |
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Telephone | 208-375-3397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 01561
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License Number State | ID
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