Provider Demographics
NPI:1205033222
Name:KLAIR, KELLY C (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:C
Last Name:KLAIR
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 1:601 EAST UNIVERSITY BLVD
Mailing Address - Street 2:FLORIDA DEPT OF HEALTH BREVARD COUNTY
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901
Mailing Address - Country:US
Mailing Address - Phone:321-726-2920
Mailing Address - Fax:321-449-5015
Practice Address - Street 1:601 EAST UNIVERSITY BLVD
Practice Address - Street 2:FLORIDA DEPT OF HEALTH BREVARD COUNTY
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-726-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN176821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice