Provider Demographics
NPI:1285843656
Name:EVELYN, KELSEY ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:ANN
Last Name:EVELYN
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 1:511 W GROVE ST STE 205
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1458
Mailing Address - Country:US
Mailing Address - Phone:617-869-3873
Mailing Address - Fax:
Practice Address - Street 1:511 W GROVE ST STE 205
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1458
Practice Address - Country:US
Practice Address - Phone:774-260-5222
Practice Address - Fax:774-260-5255
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN213771223E0200X
MA213771223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics