Provider Demographics
NPI:1841809449
Name:WILLMS, KAILAH MARIE (DDS)
Entity type:Individual
Prefix:
First Name:KAILAH
Middle Name:MARIE
Last Name:WILLMS
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 1:1115 BRYNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-7505
Mailing Address - Country:US
Mailing Address - Phone:319-961-5065
Mailing Address - Fax:
Practice Address - Street 1:4111 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4609
Practice Address - Country:US
Practice Address - Phone:319-961-5065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61683122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist