Provider Demographics
NPI:1801358676
Name:SOURVANOS, DENNIS (DDS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:SOURVANOS
Suffix:
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 1:9018 N SKYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-8501
Mailing Address - Country:US
Mailing Address - Phone:816-741-5113
Mailing Address - Fax:
Practice Address - Street 1:9018 N SKYVIEW AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-8501
Practice Address - Country:US
Practice Address - Phone:816-741-5113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240117781223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty