MEDICARE: AYHAM DAHSHAN DMD

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	62174	KS
2	122300000X	Dentist	019.033785	IL
3	1223G0001X	General Practice Dentistry	2024028457	MO

General Provider Information

NPI Number	:	1932817491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYHAM DAHSHAN DMD

Provider Business Mailing Address
First Line	:	10501 W 113TH ST APT 5339
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66210-2560
Country	:	US
Telephone Number	:	708-737-6620
Fax Number	:

Provider Business Practice Location Address
First Line	:	8600 WARD PKWY STE 2130
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-2607
Country	:	US
Telephone Number	:	816-631-1791
Fax Number	:

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

Provider Enumeration Date	:	11/14/2022
Last Update Date	:	07/25/2024

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