Individual
KELLEY MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDH
Contact information
Practice address
11644 W 75TH ST STE 101, SHAWNEE, KS 66214-1300
(913) 962-0036
Mailing address
7119 W 72ND ST, OVERLAND PARK, KS 66204-1936
(310) 363-0720
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
12702
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12702
KANSAS DENTAL BOARD
KS
Enumeration date
09/29/2021
Last updated
09/29/2021
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