# WAKASHAW, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336550607
- **Authorized official:** DR. PHILIP CHARLES GAUS DDS (OWNER/MANAGER)
- **Authorized official phone:** (785) 856-6010

## Contact information

- **Practice address:** 4901 LEGENDS DR, LAWRENCE, KS 66049-5800
- **Practice address phone:** (785) 856-6010
- **Practice address fax:** (785) 841-6480
- **Mailing address:** 4901 LEGENDS DR, LAWRENCE, KS 66049-5800
- **Mailing address phone:** (785) 856-6010
- **Mailing address fax:** (785) 841-6480

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 60952 | KS | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 6706 | KS | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | KS | Yes |

## Other

- **Enumeration date:** 05/08/2014
- **Last updated:** 07/17/2014