Provider Demographics
NPI:1780306308
Name:CONRAD, KELSEY (DMD)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 WIGWAM PKWY UNIT 11209
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8366
Mailing Address - Country:US
Mailing Address - Phone:469-274-5826
Mailing Address - Fax:
Practice Address - Street 1:1135 VITALITY DR STE 130
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-4809
Practice Address - Country:US
Practice Address - Phone:702-359-7401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV76831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice