Provider Demographics
NPI:1508187626
Name:GRUBBS, KELLI ELLEN (DDS)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:ELLEN
Last Name:GRUBBS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:ELLEN
Other - Last Name:VANHOUTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 HICKORY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72342-2302
Mailing Address - Country:US
Mailing Address - Phone:870-338-3961
Mailing Address - Fax:870-338-3950
Practice Address - Street 1:9775 HWY 64 , SUITE 101
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002
Practice Address - Country:US
Practice Address - Phone:901-235-0709
Practice Address - Fax:870-338-3950
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR37731223G0001X
TN111991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice