Healthcare Provider Details

I. General information

NPI: 1043207368
Provider Name (Legal Business Name): DANIEL VINCENT SHELDON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E PARK ST
OLATHE KS
66061
US

IV. Provider business mailing address

125 E PARK ST
OLATHE KS
66061
US

V. Phone/Fax

Practice location:
  • Phone: 913-782-7580
  • Fax: 913-782-0122
Mailing address:
  • Phone: 913-782-7580
  • Fax: 913-782-0122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6920
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: