MEDICARE: DR. MICHAEL BASHOURA DDS, MD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	62076	KS
2	122300000X	Dentist	2017019368	MO
3	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	2017019368	MO

General Provider Information

NPI Number	:	1801316435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL BASHOURA DDS, MD

Provider Business Mailing Address
First Line	:	20168 W 153RD ST
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-9131
Country	:	US
Telephone Number	:	913-839-9709
Fax Number	:

Provider Business Practice Location Address
First Line	:	20168 W 153RD ST
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-9131
Country	:	US
Telephone Number	:	913-839-9709
Fax Number	:

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

Provider Enumeration Date	:	06/24/2017
Last Update Date	:	08/22/2025

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