NPIMap

Organization Active NPI

Leavenworth Oral & Maxillofacial Surgeons PA

  • Oral and Maxillofacial Pathology Dentistry
  • Leavenworth, KS
National Provider Identifier
1609841493
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X
License
4672 Issued in KS
Legal business name
LEAVENWORTH ORAL & MAXILLOFACIAL SURGEONS PA
Practice address
3550 S 4TH St
Suite 240
Leavenworth, KS 66048-5071
Phone
(913) 772-4334
Fax
(913) 772-0851
NPI assigned
Feb 23, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Larry D Evans, D.D.S.NPI 1356316202
Title
President
Phone
(913) 772-4334

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Pathology Dentistry 1223P0106X 4672 KS Primary

Addresses

Primary practice location

3550 S 4TH St
Suite 240
Leavenworth, KS 66048-5071

Mailing address

3550 S 4TH St
Suite 240
Leavenworth, KS 66048-5071
Phone (913) 772-4334

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609841493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3550 S 4TH ST",
            "address_2": "SUITE 240",
            "city": "LEAVENWORTH",
            "state": "KS",
            "postal_code": "660485071",
            "telephone_number": "913-772-4334",
            "fax_number": "913-772-0851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 S 4TH ST",
            "address_2": "SUITE 240",
            "city": "LEAVENWORTH",
            "state": "KS",
            "postal_code": "660485071",
            "telephone_number": "913-772-4334",
            "fax_number": "913-772-0851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEAVENWORTH ORAL & MAXILLOFACIAL SURGEONS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "913-772-4334",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "KS",
            "license": "4672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leavenworth, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.