Provider Demographics
NPI:1629362546
Name:ROMOND, KELLI KONKLE (DMD)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:KONKLE
Last Name:ROMOND
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:ELIZABETH
Other - Last Name:KONKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UK COLLEGE OF DENTISTRY
Mailing Address - Street 2:800 ROSE ST
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0297
Mailing Address - Country:US
Mailing Address - Phone:859-323-9707
Mailing Address - Fax:
Practice Address - Street 1:UK COLLEGE OF DENTISTRY
Practice Address - Street 2:800 ROSE ST
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0297
Practice Address - Country:US
Practice Address - Phone:859-323-9707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY90411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice