Provider Demographics
NPI:1629299383
Name:WRENN, THOMAS H III (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:WRENN
Suffix:III
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 1:1115 E 65TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1202
Mailing Address - Country:US
Mailing Address - Phone:816-444-9091
Mailing Address - Fax:816-523-2263
Practice Address - Street 1:1115 E 65TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1202
Practice Address - Country:US
Practice Address - Phone:816-444-9091
Practice Address - Fax:816-523-2263
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO400518700Medicaid