Provider Demographics
NPI:1346263720
Name:TOOMBS, KELLY HUNTER (DDS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:HUNTER
Last Name:TOOMBS
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 1:3700 WEST 83RD STREET
Mailing Address - Street 2:SUITE 215
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208
Mailing Address - Country:US
Mailing Address - Phone:913-381-5292
Mailing Address - Fax:913-381-5293
Practice Address - Street 1:3700 WEST 83RD STREET
Practice Address - Street 2:SUITE 215
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208
Practice Address - Country:US
Practice Address - Phone:913-381-5292
Practice Address - Fax:913-381-5293
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS58741223X0400X
MO0137221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics