| Periodontal Specialist Pa | |
|
11401 Nall Avenue Leawood KS 66211-1674 | |
| (913) 663-4867 | |
| Not Available |
| Full Name | Periodontal Specialist Pa |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 11401 Nall Avenue, Leawood, Kansas |
| Authorized Official Name and Position | Daniel Thomas (OWNER/PERIODONTIST) |
| Authorized Official Contact | 9136634867 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Periodontal Specialist Pa 11401 Nall Avenue Leawood KS 66211-1674 Ph: (913) 663-4867 | Periodontal Specialist Pa 11401 Nall Avenue Leawood KS 66211-1674 Ph: (913) 663-4867 |
| NPI Number | 1497770200 |
|---|---|
| Provider Enumeration Date | 07/13/2006 |
| Last Update Date | 07/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497770200 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | (* (Not Available)) | Primary |
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