| Foundation Periodontics, Pa | |
|
8704 Bourgade St Suite 100 Lenexa KS 66219-1440 | |
| (913) 894-9962 | |
| (913) 894-9972 |
| Full Name | Foundation Periodontics, Pa |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 8704 Bourgade St, Lenexa, Kansas |
| Authorized Official Name and Position | John Kevin Mowry (PRESIDENT) |
| Authorized Official Contact | 9138949962 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Foundation Periodontics, Pa 8704 Bourgade St Suite 100 Lenexa KS 66219-1440 Ph: (913) 894-9962 | Foundation Periodontics, Pa 8704 Bourgade St Suite 100 Lenexa KS 66219-1440 Ph: (913) 894-9962 |
| NPI Number | 1295819951 |
|---|---|
| Provider Enumeration Date | 10/25/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295819951 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 7104, 7097 (Kansas) | Primary |
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