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General NPI Number Information
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NPI Number | 1619992419
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Entity Type | Organization
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Legal Business Name | PEDIATRIC SPECIALIST PA
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 11401 NALL AVENUE
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City | LEAWOOD
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State | KS
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Zip | 66211-1674
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Country | US
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Telephone | 913-649-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 11401 NALL AVE
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City | LEAWOOD
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State | KS
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Zip | 66211-1893
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Country | US
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Telephone | 913-649-5437
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. DONNA THOMAS
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Credential | DDS
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Telephone | 913-649-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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