Healthcare Provider Details

I. General information

NPI: 1801358676
Provider Name (Legal Business Name): DENNIS SOURVANOS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9018 N SKYVIEW AVE
KANSAS CITY MO
64154-8501
US

IV. Provider business mailing address

2300 EASTERN BLVD
YORK PA
17402-2818
US

V. Phone/Fax

Practice location:
  • Phone: 816-741-5113
  • Fax:
Mailing address:
  • Phone: 717-755-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS042481
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: