Provider Demographics
NPI:1447579594
Name:PLOTE, KELLY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:A
Last Name:PLOTE
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 1:2502 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1823
Mailing Address - Country:US
Mailing Address - Phone:715-379-7204
Mailing Address - Fax:
Practice Address - Street 1:4419 AIR BASE RD
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-1847
Practice Address - Country:US
Practice Address - Phone:218-728-2117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028250122300000X
MND14677122300000X
WI7050-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist