Provider Demographics
NPI:1073671624
Name:SHELEGEY, KLI ANNE J (DDS)
Entity Type:Individual
Prefix:
First Name:KLI ANNE
Middle Name:J
Last Name:SHELEGEY
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 1:721 N WASHINGTON AVE
Mailing Address - Street 2:503 PHOENIX BLDG
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708
Mailing Address - Country:US
Mailing Address - Phone:989-895-8122
Mailing Address - Fax:
Practice Address - Street 1:721 N WASHINGTON AVE
Practice Address - Street 2:503 PHOENIX BLDG
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708
Practice Address - Country:US
Practice Address - Phone:989-895-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0144961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice