Healthcare Provider Details

I. General information

NPI: 1801316435
Provider Name (Legal Business Name): MICHAEL BASHOURA DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2017
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20168 W 153RD ST
OLATHE KS
66062-9131
US

IV. Provider business mailing address

20168 W 153RD ST
OLATHE KS
66062-9131
US

V. Phone/Fax

Practice location:
  • Phone: 913-839-9709
  • Fax:
Mailing address:
  • Phone: 913-839-9709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2017019368
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number62076
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number2017019368
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: