Healthcare Provider Details

I. General information

NPI: 1245332436
Provider Name (Legal Business Name): KELLY THOMAS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4861 W 134TH ST
LEAWOOD KS
66209-7803
US

IV. Provider business mailing address

4861 W 134TH ST
LEAWOOD KS
66209-7803
US

V. Phone/Fax

Practice location:
  • Phone: 913-685-1900
  • Fax: 913-685-2002
Mailing address:
  • Phone: 913-685-1900
  • Fax: 913-685-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60505
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: