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General NPI Number Information
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NPI Number | 1346585379
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Entity Type | Organization
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Legal Business Name | DONALD D. MARDIS, DDS, PA
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Dates
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Enumeration Date | 12/03/2012
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 7450 QUIVIRA RD
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City | SHAWNEE MISSION
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State | KS
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Zip | 66216-3526
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Country | US
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Telephone | 913-217-7536
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Fax | 913-766-1019
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Provider Business Mailing Address
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Address Line | PO BOX 702620
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City | TULSA
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State | OK
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Zip | 74170-2620
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Country | US
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Telephone | 405-286-9024
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Fax | 405-286-9088
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Authorized Official
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Title or Position | OWNER/ MY DENTIST
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Name | JENNIFER CHAMBERS
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Credential | DDS
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Telephone | 405-286-9024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 60859
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License Number State | KS
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