Healthcare Provider Details

I. General information

NPI: 1376744862
Provider Name (Legal Business Name): KATHLEEN M. ELDER RDH, OM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 N MUR LEN RD #C
OLATHE KS
66062-1861
US

IV. Provider business mailing address

12882 S WIDMER ST
OLATHE KS
66062-8800
US

V. Phone/Fax

Practice location:
  • Phone: 913-829-4466
  • Fax: 913-829-0187
Mailing address:
  • Phone: 913-764-9108
  • Fax: 913-397-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number145-C-08
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: