Provider Demographics
NPI:1134258668
Name:MAIENSCHEIN, THOMAS D (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:D
Last Name:MAIENSCHEIN
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 1:620 SE STATE ROUTE 291
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-4383
Mailing Address - Country:US
Mailing Address - Phone:816-525-1666
Mailing Address - Fax:816-554-3693
Practice Address - Street 1:620 SE STATE ROUTE 291
Practice Address - Street 2:SUITE 101
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-4383
Practice Address - Country:US
Practice Address - Phone:816-525-1666
Practice Address - Fax:816-554-3693
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO128341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice