Provider Demographics
NPI:1861374449
Name:MARBEN, KELSEY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MARBEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 TANAGER PATH
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6396
Mailing Address - Country:US
Mailing Address - Phone:507-995-0323
Mailing Address - Fax:
Practice Address - Street 1:810 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-7767
Practice Address - Country:US
Practice Address - Phone:507-387-3249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDT185125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist