MEDICARE: DR. CHRIS EUGENE WENBURG D.D.S.

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	1223G0001X	General Practice Dentistry	2020005797	MO
2	122300000X	Dentist	9893	CO
3	122300000X	Dentist	6658	NE
4	122300000X	Dentist	2006015458	MO

General Provider Information

NPI Number	:	1316169485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRIS EUGENE WENBURG D.D.S.

Provider Business Mailing Address
First Line	:	608 W 50TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64112-2313
Country	:	US
Telephone Number	:	970-426-1982
Fax Number	:

Provider Business Practice Location Address
First Line	:	4320 WORNALL RD STE 500
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3235
Country	:	US
Telephone Number	:	816-561-4555
Fax Number	:	816-561-3574

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	04/27/2020

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