Provider Demographics
NPI:1902365836
Name:KELLEN GEORGE, VALERIE MAE (RDH)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:MAE
Last Name:KELLEN GEORGE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 ROBERT ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-2236
Mailing Address - Country:US
Mailing Address - Phone:651-602-7500
Mailing Address - Fax:
Practice Address - Street 1:478 ROBERT ST S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-2236
Practice Address - Country:US
Practice Address - Phone:651-602-7500
Practice Address - Fax:651-602-7518
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH4636124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist