Provider Demographics
NPI:1396397121
Name:HINKL, KELSIE BROOKE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELSIE
Middle Name:BROOKE
Last Name:HINKL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16511 WILD HORSE CREEK RD APT 321
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-1436
Mailing Address - Country:US
Mailing Address - Phone:618-791-5487
Mailing Address - Fax:
Practice Address - Street 1:824 E 6TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3109
Practice Address - Country:US
Practice Address - Phone:636-392-6728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK72221223G0001X
MO2023016438122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice