Provider Demographics
NPI:1760176093
Name:DUNN, KELLY N (DMD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:N
Last Name:DUNN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 BLAND PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63143-1213
Mailing Address - Country:US
Mailing Address - Phone:847-452-9403
Mailing Address - Fax:
Practice Address - Street 1:1775 SPRINGDALE BLVD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-5576
Practice Address - Country:US
Practice Address - Phone:636-296-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022039961122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist