Provider Demographics
NPI:1093926156
Name:KELA HALLER NESS DDS PS
Entity Type:Organization
Organization Name:KELA HALLER NESS DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELA
Authorized Official - Middle Name:HALLER
Authorized Official - Last Name:NESS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-568-5411
Mailing Address - Street 1:306 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2526
Mailing Address - Country:US
Mailing Address - Phone:360-568-5411
Mailing Address - Fax:
Practice Address - Street 1:306 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2526
Practice Address - Country:US
Practice Address - Phone:360-568-5411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000062981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty