Provider Demographics
NPI:1336110121
Name:AHERN, BRIAN DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:AHERN
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 1:10508 LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-2633
Mailing Address - Country:US
Mailing Address - Phone:913-383-9004
Mailing Address - Fax:
Practice Address - Street 1:1854 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-4166
Practice Address - Country:US
Practice Address - Phone:913-281-5538
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS62771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice