Basic Information
| Provider Information | |||||||||
| NPI: | 1265729404 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLLINGSWORTH RYALS | ||||||||
| FirstName: | KELLEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3301 CAMINO LISA | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058214422 | ||||||||
| FaxNumber: | 5057978280 | ||||||||
| Practice Location | |||||||||
| Address1: | 5901 WYOMING BLVD NE | ||||||||
| Address2: | SUITE W | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052814422 | ||||||||
| FaxNumber: | 5057978280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2011 | ||||||||
| LastUpdateDate: | 07/08/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DD3491 | NM | Y | Dental Providers | Dentist | General Practice |
No ID Information.