Provider Demographics
NPI:1326277591
Name:NELKIN, KENNETH SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:SCOTT
Last Name:NELKIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 ASH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1925
Mailing Address - Country:US
Mailing Address - Phone:913-469-6880
Mailing Address - Fax:
Practice Address - Street 1:11100 ASH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1925
Practice Address - Country:US
Practice Address - Phone:913-469-6880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS56321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice