Provider Demographics
NPI:1780205088
Name:KELSEY MP HOSTETLER DDS, SC
Entity Type:Organization
Organization Name:KELSEY MP HOSTETLER DDS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:MARIE PATTON
Authorized Official - Last Name:HOSTETLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-448-5056
Mailing Address - Street 1:6797 HORSESHOE BND
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-9211
Mailing Address - Country:US
Mailing Address - Phone:608-448-5056
Mailing Address - Fax:
Practice Address - Street 1:271 S MAIN ST
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-1470
Practice Address - Country:US
Practice Address - Phone:608-845-6612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental