Provider Demographics
NPI:1669703088
Name:WEST, KELLY LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYNN
Last Name:WEST
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 1:608 E BAILEY BOSWELL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76131-3569
Mailing Address - Country:US
Mailing Address - Phone:817-234-9378
Mailing Address - Fax:
Practice Address - Street 1:608 E BAILEY BOSWELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76131-3569
Practice Address - Country:US
Practice Address - Phone:817-234-9378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice