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General NPI Number Information
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NPI Number | 1558781419
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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 | 04/18/2014
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Last Update Date | 09/02/2016
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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 |
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Provider Business Mailing 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 |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | LORI EDMONDS
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Credential |
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Telephone | 217-540-8468
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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 |
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License Number State |
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