MEDICARE: BRIAN DAVID AHERN DDS

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	6277	KS

General Provider Information

NPI Number	:	1336110121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN DAVID AHERN DDS

Provider Business Mailing Address
First Line	:	10508 LEE BLVD
Second Line	:
City	:	LEAWOOD
State	:	KS
Zip	:	66206-2633
Country	:	US
Telephone Number	:	913-383-9004
Fax Number	:

Provider Business Practice Location Address
First Line	:	1854 MINNESOTA AVE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-4166
Country	:	US
Telephone Number	:	913-281-5538
Fax Number	:

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	07/08/2007

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