Provider Demographics
NPI:1477602498
Name:MOTSON, KELLY (DDS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MOTSON
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 1:8080 MOORSBRIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4422
Mailing Address - Country:US
Mailing Address - Phone:269-323-3020
Mailing Address - Fax:269-323-0771
Practice Address - Street 1:8080 MOORSBRIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4422
Practice Address - Country:US
Practice Address - Phone:269-323-3020
Practice Address - Fax:269-323-0771
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI194821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice