Organization
KELLY B DEETER, DDS, CHTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY B DEETER DDS (OWNER/PRESIDENT)
(785) 267-6120
Entity
Organization
Contact information
Practice address
2300 SW 29TH, TOPEKA, KS 66611-1887
(785) 267-6120
(785) 267-6928
Mailing address
2300 SW 29TH, TOPEKA, KS 66611-1887
(785) 267-6120
(785) 267-6928
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4522
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1841291846
NPI TYPE 1
KS
01
—
4522
STATE LISENCE
KS
Enumeration date
10/12/2009
Last updated
10/12/2009
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