Provider Demographics
NPI:1477531903
Name:FALES, JOHN THOMAS JR (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:FALES
Suffix:JR
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:13496 S ARAPAHO DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1553
Mailing Address - Country:US
Mailing Address - Phone:913-782-2207
Mailing Address - Fax:913-489-0028
Practice Address - Street 1:13496 S ARAPAHO DR
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1553
Practice Address - Country:US
Practice Address - Phone:913-782-2207
Practice Address - Fax:913-489-0028
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS58591223P0221X
MO0160591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100222530CMedicaid
MO405694209Medicaid