Provider Demographics
NPI:1831313550
Name:KEMP, KELLY ROBINSON (DDS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ROBINSON
Last Name:KEMP
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:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-1209
Mailing Address - Country:US
Mailing Address - Phone:817-441-7654
Mailing Address - Fax:817-441-6168
Practice Address - Street 1:619 FM 1187 NORTH
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008
Practice Address - Country:US
Practice Address - Phone:817-441-7654
Practice Address - Fax:817-441-6168
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21270122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist