MEDICARE: DR. SARA LAYNE WALLS D.D.S

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	61101	KS
2	1223P0300X	Periodontics	2011015349	MO

General Provider Information

NPI Number	:	1881960102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA LAYNE WALLS D.D.S

Provider Business Mailing Address
First Line	:	833 SW LEMANS LN STE 234
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64082-4618
Country	:	US
Telephone Number	:	816-673-3132
Fax Number	:

Provider Business Practice Location Address
First Line	:	833 SW LEMANS LN STE 234
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64082-4618
Country	:	US
Telephone Number	:	816-673-3132
Fax Number	:

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

Provider Enumeration Date	:	03/30/2012
Last Update Date	:	04/22/2016

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