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General NPI Number Information
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NPI Number | 1306840012
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Entity Type | Individual
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Provider Name | SAMUEL L DANDAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 1001 6TH AVE STE. 320
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City | LEAVENWORTH
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State | KS
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Zip | 66048-3222
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Country | US
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Telephone | 913-651-6565
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Fax | 913-651-2087
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Provider Business Mailing Address
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Address Line | 1001 6TH AVE STE 320
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City | LEAVENWORTH
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State | KS
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Zip | 66048-3248
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Country | US
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Telephone | 913-651-6565
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Fax | 913-772-8806
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35072819
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 04-30685
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License Number State | KS
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