MEDICARE: DR. DAVID J. THEIN DDS, MSD

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	1223P0300X	Periodontics	5867	KS

General Provider Information

NPI Number	:	1336179902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID J. THEIN DDS, MSD

Provider Business Mailing Address
First Line	:	5000 W 95TH ST
Second Line	:	SUITE 270
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66207-3364
Country	:	US
Telephone Number	:	913-341-4141
Fax Number	:	913-341-4432

Provider Business Practice Location Address
First Line	:	5000 W 95TH ST
Second Line	:	SUITE 270
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66207-3364
Country	:	US
Telephone Number	:	913-341-4141
Fax Number	:	913-341-4432

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. DAVID J. THEIN DDS, MSD” Practice Location

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