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General NPI Number Information
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NPI Number | 1891881595
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Entity Type | Individual
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Provider Name | CHAD CHRISTIAN WOLLARD D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 444 W 47TH STREET SUITE 210
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City | KANSAS CITY
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State | MO
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Zip | 64112-1952
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Country | US
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Telephone | 816-561-9666
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Fax | 816-561-8304
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Provider Business Mailing Address
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Address Line | 444 W 47TH STREET SUITE 210
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City | KANSAS CITY
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State | MO
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Zip | 64112-1952
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Country | US
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Telephone | 816-561-9666
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Fax | 816-561-8304
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 2000166275
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License Number State | MO
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