Provider Demographics
NPI:1114375722
Name:UTECH, KELSEY BROOKE (DDS)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:BROOKE
Last Name:UTECH
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 1:4552 BRYANT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419
Mailing Address - Country:US
Mailing Address - Phone:612-825-9826
Mailing Address - Fax:763-225-8449
Practice Address - Street 1:4552 BRYANT AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419
Practice Address - Country:US
Practice Address - Phone:612-825-1697
Practice Address - Fax:763-225-8449
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13675122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND13675OtherDENTAL LICENCE