Provider Demographics
NPI:1164977567
Name:STEINLAGE, KELLI (DDS)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:STEINLAGE
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 1:2838 N. OLIVER ST.
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220
Mailing Address - Country:US
Mailing Address - Phone:641-229-7397
Mailing Address - Fax:
Practice Address - Street 1:228 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-2403
Practice Address - Country:US
Practice Address - Phone:319-283-4981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61209122300000X
IADDS-093721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist