MEDICARE: DOUGLAS W FAIN DDS.,MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	6713	KS
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	13540	MO

General Provider Information

NPI Number	:	1013996115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS W FAIN DDS.,MD

Provider Business Mailing Address
First Line	:	20168 W 153RD ST
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-9131
Country	:	US
Telephone Number	:	913-839-9709
Fax Number	:	913-839-9471

Provider Business Practice Location Address
First Line	:	20168 W 153RD ST
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-9131
Country	:	US
Telephone Number	:	913-839-9709
Fax Number	:	913-839-9471

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	03/25/2017

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