Provider Demographics
NPI:1548351166
Name:TOMSETT, KELLEY LUCILLE (DDS)
Entity type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:LUCILLE
Last Name:TOMSETT
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 1:4650 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5600
Mailing Address - Country:US
Mailing Address - Phone:301-295-2737
Mailing Address - Fax:
Practice Address - Street 1:4650 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5638
Practice Address - Country:US
Practice Address - Phone:301-295-2737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213431223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21343OtherTEXAS DENTAL LICENSE
TX160057901Medicaid
TX80082178OtherBLUE LINK
TX80082178OtherBLUE LINK
TXU95777Medicare UPIN
TX8A8606Medicare ID - Type Unspecified