Provider Demographics
NPI:1063453207
Name:SUCHMAN, KELLY R (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:R
Last Name:SUCHMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 NW BLUE PKWY
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-1872
Mailing Address - Country:US
Mailing Address - Phone:816-525-7373
Mailing Address - Fax:816-246-0311
Practice Address - Street 1:209 NW BLUE PKWY
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-1872
Practice Address - Country:US
Practice Address - Phone:816-525-7373
Practice Address - Fax:816-246-0311
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO20001575301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice