Provider Demographics
NPI:1992225239
Name:WONDERCHECK, KELSEY ELIZABETH (DDS)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:ELIZABETH
Last Name:WONDERCHECK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:KELSEY
Other - Middle Name:ELIZABETH
Other - Last Name:MCCARTHY PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:717 MEADE STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701
Mailing Address - Country:US
Mailing Address - Phone:605-593-9023
Mailing Address - Fax:
Practice Address - Street 1:717 MEADE STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-593-9023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD1159122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDD1159OtherSOUTH DAKOTA DENTAL LICENSE