Healthcare Provider Details

I. General information

NPI: 1639494214
Provider Name (Legal Business Name): DANIEL J THOMAS, DDS PERIODONTAL SPECIALISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 NE RALPH POWELL RD
LEES SUMMIT MO
64064-2368
US

IV. Provider business mailing address

3355 NE RALPH POWELL RD
LEES SUMMIT MO
64064-2368
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-4867
  • Fax: 816-268-5873
Mailing address:
  • Phone: 816-525-4867
  • Fax: 816-268-5873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number015600
License Number StateMO

VIII. Authorized Official

Name: MS. SUSAN FREEMAN
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 913-663-4867