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General NPI Number Information
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NPI Number | 1881960102
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Entity Type | Individual
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Provider Name | SARA LAYNE WALLS D.D.S
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Gender | Female
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 04/22/2016
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Provider Practice Location Address
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Address Line | 833 SW LEMANS LN STE 234
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City | LEES SUMMIT
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State | MO
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Zip | 64082-4618
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Country | US
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Telephone | 816-673-3132
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Fax |
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Provider Business Mailing Address
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Address Line | 833 SW LEMANS LN STE 234
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City | LEES SUMMIT
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State | MO
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Zip | 64082-4618
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Country | US
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Telephone | 816-673-3132
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 61101
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 2011015349
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License Number State | MO
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