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General NPI Number Information
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NPI Number | 1336550607
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Entity Type | Organization
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Legal Business Name | WAKASHAW, LLC
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Dates
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Enumeration Date | 05/08/2014
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 4901 LEGENDS DR
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City | LAWRENCE
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State | KS
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Zip | 66049-5800
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Country | US
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Telephone | 785-856-6010
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Fax | 785-841-6480
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Provider Business Mailing Address
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Address Line | 4901 LEGENDS DR
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City | LAWRENCE
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State | KS
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Zip | 66049-5800
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Country | US
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Telephone | 785-856-6010
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Fax | 785-841-6480
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. PHILIP CHARLES GAUS
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Credential | DDS
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Telephone | 785-856-6010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 6706
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 60952
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State | KS
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