| Organization Name: | PAUL KELLUM, DDS |
| NPI Number: | 1033525431 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HENRY PAUL KELLUM (OWNER) |
| Mailing Address: | 985 Airport Rd Destin |
| State: | FL US |
| Postal Code: | 325412835 |
| Phone Number: | 8508376645 |
| Fax Number: | 8506508553 |
| NPI Enumeration Date: | 07/07/2014 |
| NPI Last Update Date: | 07/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 10931 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |