MEDICARE: SHIVAM PARBHU DDS

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	122300000X	Dentist	2018003191	MO

General Provider Information

NPI Number	:	1851897821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIVAM PARBHU DDS

Provider Business Mailing Address
First Line	:	3719 MADISON AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3813
Country	:	US
Telephone Number	:	314-550-3005
Fax Number	:

Provider Business Practice Location Address
First Line	:	3719 MADISON AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3813
Country	:	US
Telephone Number	:	314-550-3005
Fax Number	:

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

Provider Enumeration Date	:	03/30/2018
Last Update Date	:	03/30/2018

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