| NPI | 1023064607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAN M CARLSON Office Administrator 913-299-0704 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 7128) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2020-08-22 |