Provider Demographics
NPI:1730351917
Name:DOUGLAS A KELLOGG DDS PA
Entity type:Organization
Organization Name:DOUGLAS A KELLOGG DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KELLOGG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-854-9270
Mailing Address - Street 1:2733 HORSE PEN CREEK RD
Mailing Address - Street 2:SUTIE 107
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8399
Mailing Address - Country:US
Mailing Address - Phone:336-854-9270
Mailing Address - Fax:336-854-5628
Practice Address - Street 1:2733 HORSE PEN CREEK RD
Practice Address - Street 2:SUTIE 107
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8399
Practice Address - Country:US
Practice Address - Phone:336-854-9270
Practice Address - Fax:336-854-5628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental