Provider Demographics
NPI:1265729404
Name:HOLLINGSWORTH RYALS, KELLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:
Last Name:HOLLINGSWORTH RYALS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 CAMINO LISA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501
Mailing Address - Country:US
Mailing Address - Phone:505-821-4422
Mailing Address - Fax:505-797-8280
Practice Address - Street 1:5901 WYOMING BLVD NE
Practice Address - Street 2:SUITE W
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-281-4422
Practice Address - Fax:505-797-8280
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD34911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice