Healthcare Provider Details

I. General information

NPI: 1891881595
Provider Name (Legal Business Name): CHAD CHRISTIAN WOLLARD D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 W 47TH STREET SUITE 210
KANSAS CITY MO
64112-1952
US

IV. Provider business mailing address

444 W 47TH STREET SUITE 210
KANSAS CITY MO
64112-1952
US

V. Phone/Fax

Practice location:
  • Phone: 816-561-9666
  • Fax: 816-561-8304
Mailing address:
  • Phone: 816-561-9666
  • Fax: 816-561-8304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2000166275
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: