Provider Demographics
NPI:1225440696
Name:CARD ORAL AND MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:CARD ORAL AND MAXILLOFACIAL SURGERY
Other - Org Name:LEAVENWORTH ORAL AND MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:STERLING
Authorized Official - Last Name:CARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:913-772-4334
Mailing Address - Street 1:3550 S 4TH ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5071
Mailing Address - Country:US
Mailing Address - Phone:913-772-4334
Mailing Address - Fax:913-772-0851
Practice Address - Street 1:3550 S 4TH ST
Practice Address - Street 2:SUITE 240
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5071
Practice Address - Country:US
Practice Address - Phone:913-772-4334
Practice Address - Fax:913-772-0851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS609351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty