Provider Demographics
NPI:1538778576
Name:COLE, KELSIE (DDS)
Entity type:Individual
Prefix:DR
First Name:KELSIE
Middle Name:
Last Name:COLE
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 1:415 S 119TH ST W
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-1816
Mailing Address - Country:US
Mailing Address - Phone:316-941-5997
Mailing Address - Fax:316-941-5996
Practice Address - Street 1:415 S 119TH ST W
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-1816
Practice Address - Country:US
Practice Address - Phone:316-941-5997
Practice Address - Fax:316-941-5996
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61673122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS61673OtherLICENSE NUMBER