Provider Demographics
NPI:1235223389
Name:ULLSMITH, KELSEY LYNN (DMD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:ULLSMITH
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 1:1101 N FOREST ST STE 6
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5195
Mailing Address - Country:US
Mailing Address - Phone:360-647-1715
Mailing Address - Fax:360-647-2286
Practice Address - Street 1:1101 N FOREST ST STE 6
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5195
Practice Address - Country:US
Practice Address - Phone:360-647-1715
Practice Address - Fax:360-647-2286
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 87361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1393295OtherUNITED CONCORDIA