Provider Demographics
NPI:1679803753
Name:RHODES, KELCEY P (DDS)
Entity Type:Individual
Prefix:
First Name:KELCEY
Middle Name:P
Last Name:RHODES
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 1:111 W MAIN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-5331
Mailing Address - Country:US
Mailing Address - Phone:253-845-0520
Mailing Address - Fax:253-770-8643
Practice Address - Street 1:111 W MAIN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-5331
Practice Address - Country:US
Practice Address - Phone:253-845-0520
Practice Address - Fax:253-770-8643
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA11021122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist