Samuel Robert Kelly

NPI #1174018022 in Salem, Oregon

Provider Information

NPI Number: 1174018022
Entity Type: Individual
Name: Samuel Robert Kelly
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist - General Practice
Enumeration Date: Jun 23, 2018
Last Updated: Jun 23, 2018

Practice Location

Address: 3380 ASTORIA WAY NE
City: Salem
State: Oregon
ZIP Code: 97305-1667
Phone: (971) 600-0211

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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