Provider Demographics
NPI:1790888642
Name:KELSEY, AARON (DDS)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:
Last Name:KELSEY
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 1:78080 AVENIDA LA FONDA
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2923
Mailing Address - Country:US
Mailing Address - Phone:760-777-9127
Mailing Address - Fax:760-777-9129
Practice Address - Street 1:25612 CROWN VALLEY PKWY STE L7
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694
Practice Address - Country:US
Practice Address - Phone:949-347-0800
Practice Address - Fax:949-606-7219
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA538071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice