Healthcare Provider Details

I. General information

NPI: 1851070791
Provider Name (Legal Business Name): RYAN SCOTT POERTNER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13328 METCALF AVE STE 150
OVERLAND PARK KS
66213-2811
US

IV. Provider business mailing address

13328 METCALF AVE STE 150
OVERLAND PARK KS
66213-2811
US

V. Phone/Fax

Practice location:
  • Phone: 913-345-2273
  • Fax:
Mailing address:
  • Phone: 913-345-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number62059
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2023026620
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: