Healthcare Provider Details

I. General information

NPI: 1942335088
Provider Name (Legal Business Name): RICHARD S GILMAN DDS MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 WARD PARKWAY SUITE 104
KANSAS CITY MO
64114
US

IV. Provider business mailing address

9225 WARD PARKWAY SUITE 104
KANSAS CITY MO
64114
US

V. Phone/Fax

Practice location:
  • Phone: 816-444-8822
  • Fax: 816-444-0492
Mailing address:
  • Phone: 816-444-8822
  • Fax: 816-444-0492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2003010617
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number012701
License Number StateMO

VIII. Authorized Official

Name: RICHARD S GILMAN
Title or Position: PRESIDENT PERIODONTIST
Credential: DDS MS
Phone: 816-444-8822