Provider Demographics
NPI:1386675825
Name:THOMPSON, KELLEY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:S
Last Name:THOMPSON
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 1:8201 MISSION RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-5212
Mailing Address - Country:US
Mailing Address - Phone:913-652-9844
Mailing Address - Fax:913-381-4286
Practice Address - Street 1:8201 MISSION RD
Practice Address - Street 2:SUITE 260
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-5212
Practice Address - Country:US
Practice Address - Phone:913-652-9844
Practice Address - Fax:913-341-4432
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS69141223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics