Provider Demographics
NPI:1770571952
Name:PENDLETON, STEVEN D (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:PENDLETON
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 1:8919 PARALLEL PKWY
Mailing Address - Street 2:SUITE #309
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-1636
Mailing Address - Country:US
Mailing Address - Phone:913-299-0704
Mailing Address - Fax:913-299-3008
Practice Address - Street 1:8919 PARALLEL PKWY
Practice Address - Street 2:SUITE #309
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1636
Practice Address - Country:US
Practice Address - Phone:913-299-0704
Practice Address - Fax:913-299-3008
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS71281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100314980BMedicaid