Provider Demographics
NPI:1326155177
Name:EDIGER, KORY (DDS)
Entity Type:Individual
Prefix:
First Name:KORY
Middle Name:
Last Name:EDIGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21714 W 98TH ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66220-2666
Mailing Address - Country:US
Mailing Address - Phone:913-825-0852
Mailing Address - Fax:913-631-9299
Practice Address - Street 1:11005 W 60TH ST
Practice Address - Street 2:STE. 240
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66203-2913
Practice Address - Country:US
Practice Address - Phone:913-631-5622
Practice Address - Fax:913-631-9299
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS640281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice