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General NPI Number Information
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NPI Number | 1376744862
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Entity Type | Individual
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Provider Name | KATHLEEN M. ELDER RDH, OM
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Gender | Female
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 975 N MUR LEN RD #C
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City | OLATHE
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State | KS
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Zip | 66062-1861
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Country | US
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Telephone | 913-829-4466
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Fax | 913-829-0187
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Provider Business Mailing Address
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Address Line | 12882 S WIDMER ST
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City | OLATHE
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State | KS
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Zip | 66062-8800
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Country | US
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Telephone | 913-764-9108
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Fax | 913-397-6513
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 145-C-08
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License Number State | KS
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