Provider Demographics
NPI:1992528699
Name:OGLE, KELLY DENISE (RDH)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:DENISE
Last Name:OGLE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7627 LONG SHOT LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-8512
Mailing Address - Country:US
Mailing Address - Phone:865-382-1347
Mailing Address - Fax:
Practice Address - Street 1:7627 LONG SHOT LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-8512
Practice Address - Country:US
Practice Address - Phone:865-382-1347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5653124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist