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General NPI Number Information
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NPI Number | 1396245775
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Entity Type | Organization
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Legal Business Name | GENMAT, PA
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Dates
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Enumeration Date | 02/13/2018
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 1320 CENTRAL AVE
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City | KANSAS CITY
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State | KS
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Zip | 66102-5030
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Country | US
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Telephone | 913-342-5280
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Fax |
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Provider Business Mailing Address
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Address Line | 12180 S 300 E UNIT 270
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City | DRAPER
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State | UT
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Zip | 84020-2612
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Country | US
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Telephone | 385-215-6097
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATHEW H DRAPER
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Credential | DDS
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Telephone | 385-215-6097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 61292
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License Number State | KS
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