Healthcare Provider Details

I. General information

NPI: 1649915059
Provider Name (Legal Business Name): DANTE CARLO PENNIPEDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10120 W 119TH ST
OVERLAND PARK KS
66213-1600
US

IV. Provider business mailing address

10120 W 119TH ST
OVERLAND PARK KS
66213-1600
US

V. Phone/Fax

Practice location:
  • Phone: 913-339-9090
  • Fax: 913-339-6417
Mailing address:
  • Phone: 913-339-9090
  • Fax: 913-339-6417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number94-11126
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: