Provider Demographics
NPI:1669212007
Name:WAUGH, DYLAN JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:JAMES
Last Name:WAUGH
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 1:325 SE WILSON ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2715
Mailing Address - Country:US
Mailing Address - Phone:816-525-0399
Mailing Address - Fax:
Practice Address - Street 1:325 SE WILSON ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2715
Practice Address - Country:US
Practice Address - Phone:816-525-0399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024019735122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist