MEDICARE: DR. MARY LYNN STANTON DMD, FAGD

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	122300000X	Dentist	2000157357	MO
2	122300000X	Dentist	60059	KS

General Provider Information

NPI Number	:	1336163518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY LYNN STANTON DMD, FAGD

Provider Business Mailing Address
First Line	:	4801 E LINWOOD BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64128-2226
Country	:	US
Telephone Number	:	816-861-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	5508 CENTRAL ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64113-1206
Country	:	US
Telephone Number	:	816-363-4484
Fax Number	:

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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