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General NPI Number Information
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NPI Number | 1417133521
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Entity Type | Organization
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Legal Business Name | JOHNSON COUNTY DENTAL CARE
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 5329 W 94TH TER
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66207-2503
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Country | US
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Telephone | 913-341-7440
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Fax | 913-341-6220
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Provider Business Mailing Address
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Address Line | 5329 W 94TH TER
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66207-2503
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Country | US
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Telephone | 913-341-7440
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Fax | 913-341-6220
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Authorized Official
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Title or Position | DENTIST
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Name | LISA A THURLOW
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Credential | D.D.S.
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Telephone | 913-341-7440
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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 | 6925
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License Number State | KS
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