Provider Demographics
NPI:1013923895
Name:WALDRON, JOHN A JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:WALDRON
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 1:801 W 47TH ST
Mailing Address - Street 2:SUITE 408
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-1377
Mailing Address - Country:US
Mailing Address - Phone:816-561-6150
Mailing Address - Fax:816-561-6738
Practice Address - Street 1:801 W 47TH ST
Practice Address - Street 2:SUITE 408
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1377
Practice Address - Country:US
Practice Address - Phone:816-561-6150
Practice Address - Fax:816-561-6738
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO127541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice