MR. Kelly B Bosworth, DDS 9311

NPI #1174615306 in Shorewood, Minnesota

Provider Information

NPI Number: 1174615306
Entity Type: Individual
Name: MR. Kelly B Bosworth, DDS 9311
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist
Credential: DDS 9311
Enumeration Date: Sep 28, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 24000 HWY 7
Address 2: SUITE 120 KELLY BOSWORTH FAMILY DENTISTRY
City: Shorewood
State: Minnesota
ZIP Code: 55331
Phone: (952) 474-4123

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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