Healthcare Provider Details

I. General information

NPI: 1861457681
Provider Name (Legal Business Name): GERALD WOOLSEY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 11/26/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UMKC SCHOOL OF DENTISTRY 650 E 25TH STREET
KANSAS CITY MO
64108
US

IV. Provider business mailing address

6296 KENNETT PLACE
MISSION KS
66202
US

V. Phone/Fax

Practice location:
  • Phone: 816-235-2100
  • Fax:
Mailing address:
  • Phone: 816-914-7387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number015569
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: