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General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1619927092

Individual Registrant:
Gender: M

Location and contact information for practice:
32980 W 83RD STREET  DESOTO, KS 66018 US
Tel: 913-583-3233  Fax: 913-585-1510

Contact information for business:
PO BOX 418  DESOTO, KS 66018 US
Tel: 913-583-3233  Fax: 913-585-1510

Registration Information:
NPI: 1619927092
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
General Practice

Legacy codes, insurance codes and state license numbers:



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