Provider Demographics
NPI:1225829427
Name:DEPNER, KELLY (RDH)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:DEPNER
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 1:1651 S JUNIPER ST UNIT 145
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6165
Mailing Address - Country:US
Mailing Address - Phone:760-520-5013
Mailing Address - Fax:
Practice Address - Street 1:6994 EL CAMINO REAL STE 108
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-4117
Practice Address - Country:US
Practice Address - Phone:760-431-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30578124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist