Provider Demographics
NPI:1194848556
Name:DUMAS, KELLI MULHOLLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:MULHOLLEN
Last Name:DUMAS
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 1:50 N FRONT ST STE 870
Mailing Address - Street 2:MORGAN KEEGAN TOWER
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-1108
Mailing Address - Country:US
Mailing Address - Phone:901-526-9111
Mailing Address - Fax:901-526-5111
Practice Address - Street 1:50 N FRONT ST STE 870
Practice Address - Street 2:MORGAN KEEGAN TOWER
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-1108
Practice Address - Country:US
Practice Address - Phone:901-526-9111
Practice Address - Fax:901-526-5111
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0068441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice