Provider Demographics
NPI:1538664297
Name:ARORA PERIODONTICS, L.L.C.
Entity Type:Organization
Organization Name:ARORA PERIODONTICS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING AND CREDENTIALING AGEN
Authorized Official - Prefix:
Authorized Official - First Name:ASHLI
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:785-766-2363
Mailing Address - Street 1:4901 W 136TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-7900
Mailing Address - Country:US
Mailing Address - Phone:913-624-3636
Mailing Address - Fax:
Practice Address - Street 1:4901 W 136TH ST STE B
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224-7900
Practice Address - Country:US
Practice Address - Phone:913-624-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60819261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental