Provider Demographics
NPI:1275100216
Name:CIOCH, KELLY (DDS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CIOCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:SMOLTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:460 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY MILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76689-3033
Mailing Address - Country:US
Mailing Address - Phone:734-578-7253
Mailing Address - Fax:
Practice Address - Street 1:421 N ROBINSON DR
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:TX
Practice Address - Zip Code:76706-5303
Practice Address - Country:US
Practice Address - Phone:254-662-3306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX372091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice