MEDICARE: DR. DOUGLAS JON SJOGREN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6907	KS

General Provider Information

NPI Number	:	1336144369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS JON SJOGREN D.D.S.

Provider Business Mailing Address
First Line	:	13772 S BLACKBOB RD
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-1932
Country	:	US
Telephone Number	:	913-469-8019
Fax Number	:	913-469-1462

Provider Business Practice Location Address
First Line	:	13772 S BLACKBOB RD
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-1932
Country	:	US
Telephone Number	:	913-469-8019
Fax Number	:	913-469-1462

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	01/12/2010

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