Provider Demographics
NPI:1760594287
Name:MARENGO, ANTHONY JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:MARENGO
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 1:16103 W 135TH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1516
Mailing Address - Country:US
Mailing Address - Phone:913-829-9222
Mailing Address - Fax:913-829-7121
Practice Address - Street 1:16103 W 135TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1516
Practice Address - Country:US
Practice Address - Phone:891-382-9922
Practice Address - Fax:913-829-7121
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS63101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice