Healthcare Provider Details

I. General information

NPI: 1497608319
Provider Name (Legal Business Name): NICHOLAS JOSEPH NATANOV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NICK JOSEPH NATANOV

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11504 W 135TH ST
OVERLAND PARK KS
66221-2892
US

IV. Provider business mailing address

11611 W 132ND TER
OVERLAND PARK KS
66213-4536
US

V. Phone/Fax

Practice location:
  • Phone: 913-948-9488
  • Fax:
Mailing address:
  • Phone: 913-406-2154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number62401
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: