Healthcare Provider Details

I. General information

NPI: 1447420526
Provider Name (Legal Business Name): THOMAS DDS PERIODONTAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 NE BARRY RD
KANSAS CITY MO
64155-2721
US

IV. Provider business mailing address

209 NE BARRY RD
KANSAS CITY MO
64155-2721
US

V. Phone/Fax

Practice location:
  • Phone: 816-436-6767
  • Fax: 816-436-6766
Mailing address:
  • Phone: 816-436-6767
  • Fax: 816-436-6766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number015600
License Number StateKS

VIII. Authorized Official

Name: DANIEL THOMAS
Title or Position: PERIODONTIST
Credential: DDS
Phone: 816-436-6767