Healthcare Provider Details

I. General information

NPI: 1568683423
Provider Name (Legal Business Name): ADAM S COLOMBO, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 MISSION RD STE 317
PRAIRIE VILLAGE KS
66208-3006
US

IV. Provider business mailing address

7301 MISSION RD STE 317
PRAIRIE VILLAGE KS
66208-3006
US

V. Phone/Fax

Practice location:
  • Phone: 913-236-7668
  • Fax: 913-432-4520
Mailing address:
  • Phone: 913-236-7668
  • Fax: 913-432-4520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number60318
License Number StateKS

VIII. Authorized Official

Name: ADAM S COLOMBO
Title or Position: OWNER
Credential: DDS
Phone: 913-236-7668