Provider Demographics
NPI:1245591296
Name:RAMIREZ, KELLY J (RDH)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:J
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-1195
Mailing Address - Country:US
Mailing Address - Phone:608-643-8905
Mailing Address - Fax:608-643-8905
Practice Address - Street 1:1906 NORTH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-1148
Practice Address - Country:US
Practice Address - Phone:608-644-0504
Practice Address - Fax:608-644-0504
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6605-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist