Provider Demographics
NPI:1649704636
Name:SANTARELLI, KELLY M (DDS)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:M
Last Name:SANTARELLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:M
Other - Last Name:ZOOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16263 E GIRARD PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-1925
Mailing Address - Country:US
Mailing Address - Phone:720-422-8686
Mailing Address - Fax:
Practice Address - Street 1:7720 S BROADWAY STE 430
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2624
Practice Address - Country:US
Practice Address - Phone:303-795-1443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2018-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002035491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice