Provider Demographics
NPI:1518511583
Name:KELL, JOSHUA RYAN (DMD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:RYAN
Last Name:KELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 STONELEDGE DR APT 1113
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-1131
Mailing Address - Country:US
Mailing Address - Phone:817-966-9109
Mailing Address - Fax:
Practice Address - Street 1:2600 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2327
Practice Address - Country:US
Practice Address - Phone:903-201-4374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist