Provider Demographics
NPI:1821586603
Name:WALDO ORAL SURGERY, LLC
Entity Type:Organization
Organization Name:WALDO ORAL SURGERY, LLC
Other - Org Name:WALDO DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL MANAGER OF BILLING & INS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAMBURELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-830-9030
Mailing Address - Street 1:8043 WORNALL RD STE 201
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-5822
Mailing Address - Country:US
Mailing Address - Phone:816-214-8339
Mailing Address - Fax:816-216-1742
Practice Address - Street 1:8043 WORNALL RD STE 201
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-5822
Practice Address - Country:US
Practice Address - Phone:816-214-8339
Practice Address - Fax:816-216-1742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160117251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty