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General NPI Number Information
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NPI Number | 1821586603
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Entity Type | Organization
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Legal Business Name | WALDO ORAL SURGERY, LLC
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Dates
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Enumeration Date | 04/26/2018
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 8043 WORNALL RD STE 201
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City | KANSAS CITY
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State | MO
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Zip | 64114-5822
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Country | US
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Telephone | 816-214-8339
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Fax | 816-216-1742
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Provider Business Mailing Address
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Address Line | 8043 WORNALL RD STE 201
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City | KANSAS CITY
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State | MO
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Zip | 64114-5822
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Country | US
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Telephone | 816-214-8339
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Fax | 816-216-1742
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Authorized Official
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Title or Position | REGIONAL MANAGER OF BILLING & INS
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Name | MRS. ALICIA A TAMBURELLO
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Credential |
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Telephone | 816-830-9030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2016011725
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License Number State | MO
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