Provider Demographics
NPI:1013930445
Name:PAXTON, KELLIE (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:
Last Name:PAXTON
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 WILLIAMSON RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-7610
Mailing Address - Country:US
Mailing Address - Phone:704-799-0110
Mailing Address - Fax:
Practice Address - Street 1:202 WILLIAMSON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-7610
Practice Address - Country:US
Practice Address - Phone:704-799-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95831223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics