# DONALD D. MARDIS, DDS, PA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DONALD D. MARDIS, DDS, PA
- **Other names:** Quivira Dental Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1558781419
- **Legal business name:** DONALD D. MARDIS, DDS, PA
- **Authorized official:** LORI EDMONDS (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (217) 540-8468

## Contact information

- **Practice address:** 7450 QUIVIRA RD, SHAWNEE MISSION, KS 66216-3526
- **Practice address phone:** (913) 217-7536
- **Mailing address:** 7450 QUIVIRA RD, SHAWNEE MISSION, KS 66216-3526

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 04/18/2014
- **Last updated:** 09/02/2016