Healthcare Provider Details

I. General information

NPI: 1336110121
Provider Name (Legal Business Name): BRIAN DAVID AHERN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1854 MINNESOTA AVE
KANSAS CITY KS
66102-4166
US

IV. Provider business mailing address

10508 LEE BLVD
LEAWOOD KS
66206-2633
US

V. Phone/Fax

Practice location:
  • Phone: 913-281-5538
  • Fax:
Mailing address:
  • Phone: 913-383-9004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6277
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: