Provider Demographics
NPI:1245439892
Name:PAGE, KELLY ROBERTSON (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ROBERTSON
Last Name:PAGE
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 1:300 JADE PARK
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CHELSEA
Mailing Address - State:AL
Mailing Address - Zip Code:35043-1704
Mailing Address - Country:US
Mailing Address - Phone:205-678-2770
Mailing Address - Fax:
Practice Address - Street 1:300 JADE PARK
Practice Address - Street 2:SUITE 301
Practice Address - City:CHELSEA
Practice Address - State:AL
Practice Address - Zip Code:35043-1704
Practice Address - Country:US
Practice Address - Phone:205-678-2770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics