Randall James Kelley, D.M.D. Valid NPI
Individual provider · General Practice Dentistry · Provo, UT
- NPI
- 1538387154
- Type
- Individual (Type 1)
- Primary specialty
- General Practice Dentistry (Dentist)
- Specialty group
- Dental Providers
- Taxonomy code
- 1223G0001X
- License number
- 33052 (CA)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2007-04-20
- Last updated
- 2007-07-08
Practice location
275 N 500 W, Suite C
Provo, UT 84601-3006
(801) 374-5768