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General NPI Number Information
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NPI Number | 1447420526
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Entity Type | Organization
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Legal Business Name | THOMAS DDS PERIODONTAL SPECIALISTS
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 209 NE BARRY RD
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City | KANSAS CITY
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State | MO
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Zip | 64155-2721
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Country | US
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Telephone | 816-436-6767
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Fax | 816-436-6766
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Provider Business Mailing Address
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Address Line | 209 NE BARRY RD
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City | KANSAS CITY
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State | MO
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Zip | 64155-2721
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Country | US
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Telephone | 816-436-6767
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Fax | 816-436-6766
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Authorized Official
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Title or Position | PERIODONTIST
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Name | DANIEL THOMAS
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Credential | DDS
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Telephone | 816-436-6767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 015600
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License Number State | KS
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