MRS. Shasta Marie Kellerby, RDH

NPI #1417228404 in Rifle, Colorado

Provider Information

NPI Number: 1417228404
Entity Type: Individual
Name: MRS. Shasta Marie Kellerby, RDH
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dental Hygienist
Credential: RDH
Enumeration Date: Jan 23, 2012
Last Updated: Jan 23, 2012

Practice Location

Address: 195 W 14TH
City: Rifle
State: Colorado
ZIP Code: 81650-4700
Phone: (970) 625-5200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dental Hygienist	124Q00000X	Primary

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