Provider Demographics
NPI:1326674607
Name:MICHELLE M KELMAN DDS PC
Entity Type:Organization
Organization Name:MICHELLE M KELMAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-599-0000
Mailing Address - Street 1:8635 W 3RD ST STE 255W
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6113
Mailing Address - Country:US
Mailing Address - Phone:818-599-0000
Mailing Address - Fax:310-659-9185
Practice Address - Street 1:8635 W 3RD ST STE 255W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6113
Practice Address - Country:US
Practice Address - Phone:818-599-0000
Practice Address - Fax:310-659-9185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty