Provider Demographics
NPI:1437148731
Name:BAGBY, THOMAS K JR (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:K
Last Name:BAGBY
Suffix:JR
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 1:6728 CHEROKEE LN
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:KS
Mailing Address - Zip Code:66208-2158
Mailing Address - Country:US
Mailing Address - Phone:913-722-3878
Mailing Address - Fax:
Practice Address - Street 1:6610 PARALLEL AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1047
Practice Address - Country:US
Practice Address - Phone:913-299-4100
Practice Address - Fax:913-299-4105
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice