Provider Demographics
NPI:1851574867
Name:KELLEY, MICHAEL FRANK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FRANK
Last Name:KELLEY
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:PO BOX 659
Mailing Address - Street 2:
Mailing Address - City:WALTERVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97489-0659
Mailing Address - Country:US
Mailing Address - Phone:541-896-3280
Mailing Address - Fax:
Practice Address - Street 1:1400 MILL ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4259
Practice Address - Country:US
Practice Address - Phone:541-344-8328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8037122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist