Provider Demographics
NPI:1245899350
Name:GEORGE, KELSEY A
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:A
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-6880
Mailing Address - Country:US
Mailing Address - Phone:250-876-1530
Mailing Address - Fax:508-761-3180
Practice Address - Street 1:288 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SOUTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-6880
Practice Address - Country:US
Practice Address - Phone:250-876-1530
Practice Address - Fax:508-761-3180
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18573191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics