Provider Demographics
NPI:1487179735
Name:QUICK, KELSEY
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:QUICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 GAFFNEY RD. #7440
Mailing Address - Street 2:
Mailing Address - City:FT. WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-7440
Mailing Address - Country:US
Mailing Address - Phone:907-361-5603
Mailing Address - Fax:907-361-4847
Practice Address - Street 1:1060 GAFFNEY RD. #7440
Practice Address - Street 2:
Practice Address - City:FT. WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703
Practice Address - Country:US
Practice Address - Phone:907-361-5603
Practice Address - Fax:907-361-4847
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist