Healthcare Provider Details

I. General information

NPI: 1386675825
Provider Name (Legal Business Name): KELLEY S. THOMPSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 MISSION RD SUITE 260
PRAIRIE VILLAGE KS
66208-5212
US

IV. Provider business mailing address

8201 MISSION RD SUITE 260
PRAIRIE VILLAGE KS
66208-5212
US

V. Phone/Fax

Practice location:
  • Phone: 913-652-9844
  • Fax: 913-341-4432
Mailing address:
  • Phone: 913-652-9844
  • Fax: 913-381-4286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number6914
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: