Provider Demographics
NPI:1639272214
Name:KENNETH NELKIN DDS PA
Entity Type:Organization
Organization Name:KENNETH NELKIN DDS PA
Other - Org Name:KENNETH NELKIN
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:NELKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-897-5653
Mailing Address - Street 1:13805 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223
Mailing Address - Country:US
Mailing Address - Phone:913-897-5653
Mailing Address - Fax:
Practice Address - Street 1:11755 W 112TH ST
Practice Address - Street 2:ST 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210
Practice Address - Country:US
Practice Address - Phone:913-897-5653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5632122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty