Provider Demographics
NPI:1174589865
Name:KRISS, THOMAS A (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:KRISS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 CHESTNUT
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801
Mailing Address - Country:US
Mailing Address - Phone:620-342-8256
Mailing Address - Fax:620-412-4316
Practice Address - Street 1:1212 CHESTNUT
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801
Practice Address - Country:US
Practice Address - Phone:620-342-8256
Practice Address - Fax:620-412-4316
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS70811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
116835OtherBLUE CROSS BLUE SHIELD
KS100289310BMedicaid
1005132OtherDORAL PROVIDER ID