Provider Demographics
NPI:1003702093
Name:MCENANEY, KELSI (DDS)
Entity type:Individual
Prefix:
First Name:KELSI
Middle Name:
Last Name:MCENANEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 ONTARIO ST SE APT 208
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3281
Mailing Address - Country:US
Mailing Address - Phone:406-493-2295
Mailing Address - Fax:
Practice Address - Street 1:2036 ROBERT ST S
Practice Address - Street 2:
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3923
Practice Address - Country:US
Practice Address - Phone:651-457-5762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND15308122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist