Provider Demographics
NPI:1083095228
Name:PRESCOTT, KELLI M (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:M
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N MIAMI BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3716
Mailing Address - Country:US
Mailing Address - Phone:305-947-9001
Mailing Address - Fax:
Practice Address - Street 1:900 N MIAMI BEACH BLVD
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3716
Practice Address - Country:US
Practice Address - Phone:305-947-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-13
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL212841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice