Provider Demographics
NPI:1598744377
Name:KELLENBERGER, GALEN ARTHUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GALEN
Middle Name:ARTHUR
Last Name:KELLENBERGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9650 HWY E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MO
Mailing Address - Zip Code:65483-2616
Mailing Address - Country:US
Mailing Address - Phone:913-954-7953
Mailing Address - Fax:
Practice Address - Street 1:3000 INDEPENDENCE SQ
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-4239
Practice Address - Country:US
Practice Address - Phone:913-754-6026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60334122300000X
MO20080309921223G0001X
ORD108011223G0001X
MO2021039552122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice