MEDICARE: DR. EDWARD JOHN BAZAR III D.M.D.

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	2003025550	MO

General Provider Information

NPI Number	:	1386631703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD JOHN BAZAR III D.M.D.

Provider Business Mailing Address
First Line	:	1301 SW ARBORWALK BLVD STE E
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64082-4101
Country	:	US
Telephone Number	:	816-623-9999
Fax Number	:	816-623-9998

Provider Business Practice Location Address
First Line	:	1301 SW ARBORWALK BLVD STE E
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64082-4101
Country	:	US
Telephone Number	:	816-623-9999
Fax Number	:	816-623-9998

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	04/03/2018

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