Provider Demographics
NPI:1265790471
Name:MILBERT, KELSEY
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:
Last Name:MILBERT
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 1:1514 E MINNESOTA ST
Mailing Address - Street 2:PO BOX 607
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MN
Mailing Address - Zip Code:56374-8618
Mailing Address - Country:US
Mailing Address - Phone:320-363-7729
Mailing Address - Fax:
Practice Address - Street 1:1514 E MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MN
Practice Address - Zip Code:56374-8618
Practice Address - Country:US
Practice Address - Phone:320-363-7729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND130621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice