Provider Demographics
NPI:1720460793
Name:KAELKE, KINDEL J (DDS)
Entity Type:Individual
Prefix:
First Name:KINDEL
Middle Name:J
Last Name:KAELKE
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 1:3608 FARAON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3044
Mailing Address - Country:US
Mailing Address - Phone:816-364-6444
Mailing Address - Fax:816-364-6929
Practice Address - Street 1:3608 FARAON ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3044
Practice Address - Country:US
Practice Address - Phone:816-364-6444
Practice Address - Fax:816-364-6929
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150202921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice