MEDICARE: CHAD CHRISTIAN WOLLARD D.M.D.

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	1223E0200X	Endodontics	2000166275	MO

General Provider Information

NPI Number	:	1891881595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAD CHRISTIAN WOLLARD D.M.D.

Provider Business Mailing Address
First Line	:	444 W 47TH STREET
Second Line	:	SUITE 210
City	:	KANSAS CITY
State	:	MO
Zip	:	64112-1952
Country	:	US
Telephone Number	:	816-561-9666
Fax Number	:	816-561-8304

Provider Business Practice Location Address
First Line	:	444 W 47TH STREET
Second Line	:	SUITE 210
City	:	KANSAS CITY
State	:	MO
Zip	:	64112-1952
Country	:	US
Telephone Number	:	816-561-9666
Fax Number	:	816-561-8304

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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