PERIODONTAL SPECIALIST PA (NPI# 1497770200) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497770200 |
| Entity Type | Organization |
| Organization Name | PERIODONTAL SPECIALIST PA |
| Practice Address |
11401 Nall Avenue Leawood KS 66211-1674 |
| Practice Telephone | 9136634867 |
| Mailing Telephone | 9136634867 |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2008-07-17 |
| Authorized Official Name | DR. DANIEL THOMAS (OWNER/PERIODONTIST) |
| Authorized Official Telephone | 9136634867 |
| Authorized Official Credential | DDS MS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers |
| Street Address |
11401 NALL AVENUE |
| City | LEAWOOD |
| State | KS |
| Zip Code | 66211-1674 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619992419 | Pediatric Specialist Pa | Dentist | 11401 Nall Avenue, Leawood, KS 66211-1674 | 2006-07-13 |
| 1124129846 | Metropolitian Surgical Associates, Pa | Surgery | 11401 Nall Avenue, Suite 216, Leawood, KS 66211 | 2006-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336611821 | Baillie Rose Woydziak | Social Worker | 5805 W 110th Street, Overland Park, KS 66211 | 2018-12-20 |
| 1467920389 | Ku Medwest Ambulatory Surgery Center, LLC | Clinic/Center | 10720 Nall Avenue, Overland Park, KS 66211 | 2018-11-08 |
| 1235615931 | Janice Carollo | Physical Therapy Assistant | 11611 Granada Lane, Leawood, KS 66211 | 2018-07-16 |
| 1720572555 | Trevor Lee Elmer | Physical Therapist | 10777 Nall, 320 - Corporate Medical Plaza Building II, Overland Park, KS 66211 | 2018-06-15 |
| 1043746555 | Overland Park Surgical Suites, LLC | Clinic/Center | 6650 W 110th St Ste 300, Overland Park, KS 66211 | 2017-05-03 |
| 1619313665 | Vcphcs Xiv, LLC | Clinic/Center | 6331 W. 110th Street, Overland Park, KS 66211 | 2013-05-17 |
| 1528334950 | Scott Anthony Hardouin | Surgery | 5100 W 110th St Unit 300, Overland Park, KS 66211 | 2012-03-29 |
| 1386917003 | Children's Physical Therapy Associates | Physical Therapist | 6600 College Boulevard, Suite 307, Overland Park, KS 66211 | 2012-02-10 |
| 1871876250 | Amber Diane Dalzell | Social Worker | 10965 Granada Ln Ste 102, Overland Park, KS 66211 | 2011-09-22 |
| 1912298001 | Stephen Vincent Hiatt | Orthopaedic Surgery | 10701 Nall Avenue, Suite 200, Overland Park, KS 66211 | 2011-04-25 |
| Find all providers in zip 66211 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861514572 | Richard A Hines | Dentist | 11237 Nall Ave Ste 140, Leawood, KS 66211-1639 | 2007-04-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558883181 | Periodontal Care, P.a. | Dentist | 5000 W 95th St Ste 270, Prairie Village, KS 66207-3300 | 2017-07-14 |
| 1598106460 | Mark P Hagan | Dentist | 2981 N Webb Rd, Wichita, KS 67226 | 2013-07-08 |
| 1275723397 | David Lewis May | Dentist | 233 N Hillside St, Wichita, KS 67214-4903 | 2007-07-25 |
| 1114135381 | Jeffrey Craig Hambleton | Dentist | 1440 Wakarusa Dr, Ste 300, Lawrence, KS 66049-4090 | 2007-05-19 |
| 1225254295 | Julie C. Swift, Dds, Pa | Dentist | 634 Sw Mulvane St Ste 306, Topeka, KS 66606-1678 | 2007-04-18 |
| 1407978232 | Keerthana M Satheesh | Dentist | 10870 Benson St, Bldg. 21 Suite 2100, Overland Park, KS 66210-1502 | 2007-04-04 |
| 1063573483 | Mcknight & Oliver Periodontics | Dentist | 2200 W 75th Street, Prairie Village, KS 66208 | 2006-12-12 |
| 1295819951 | Foundation Periodontics, Pa | Dentist | 8704 Bourgade St, Suite 100, Lenexa, KS 66219-1440 | 2006-10-25 |
| 1932283256 | Jason E Wagle | Dentist | 2981 N Webb Rd., Wichita, KS 67226 | 2006-10-24 |
| 1245328236 | Kansas Periodontics & Dental Implants LLC | Dentist | 2981 N. Webb Rd., Wichita, KS 67226 | 2006-10-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.