Provider Demographics
NPI:1225212947
Name:MORI, KELLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLEN
Middle Name:
Last Name:MORI
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 1:923 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2649
Mailing Address - Country:US
Mailing Address - Phone:212-734-6111
Mailing Address - Fax:212-472-1689
Practice Address - Street 1:923 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2649
Practice Address - Country:US
Practice Address - Phone:212-734-6111
Practice Address - Fax:212-472-1689
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05064-18122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist