Healthcare Provider Details

I. General information

NPI: 1346638814
Provider Name (Legal Business Name): DONNA THOMAS DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3359 NE RALPH POWELL RD
LEE'S SUMMIT MO
64064
US

IV. Provider business mailing address

3359 NE RALPH POWELL RD
LEE'S SUMMIT MO
64064
US

V. Phone/Fax

Practice location:
  • Phone: 816-875-1435
  • Fax: 816-524-2338
Mailing address:
  • Phone: 816-875-1435
  • Fax: 816-524-2338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6904
License Number StateKS

VIII. Authorized Official

Name: MRS. SUSAN GRAY
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 913-663-4867