Provider Demographics
NPI:1306948559
Name:WALTERS, KINSEY LEE (DDS)
Entity type:Individual
Prefix:
First Name:KINSEY
Middle Name:LEE
Last Name:WALTERS
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 1:10200 W. 87TH ST.
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212
Mailing Address - Country:US
Mailing Address - Phone:913-283-7310
Mailing Address - Fax:913-289-4369
Practice Address - Street 1:10200 W. 87TH ST.
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212
Practice Address - Country:US
Practice Address - Phone:913-283-7310
Practice Address - Fax:913-289-4369
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60432122300000X
MO2006021037122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist