Provider Demographics
NPI:1699809111
Name:KELLOGG, KAREN VALENTINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:VALENTINE
Last Name:KELLOGG
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 1:935 EVENTIDE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5559
Mailing Address - Country:US
Mailing Address - Phone:210-824-0203
Mailing Address - Fax:210-824-2330
Practice Address - Street 1:935 EVENTIDE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5559
Practice Address - Country:US
Practice Address - Phone:210-824-0203
Practice Address - Fax:210-824-2330
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16202122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist