# LEAVENWORTH ORAL & MAXILLOFACIAL SURGEONS PA

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

## Provider details

- **NPI number:** 1609841493
- **Authorized official:** DR. LARRY D EVANS D.D.S. (PRESIDENT)
- **Authorized official phone:** (913) 772-4334

## Contact information

- **Practice address:** 3550 S 4TH ST, SUITE 240, LEAVENWORTH, KS 66048-5071
- **Practice address phone:** (913) 772-4334
- **Practice address fax:** (913) 772-0851
- **Mailing address:** 3550 S 4TH ST, SUITE 240, LEAVENWORTH, KS 66048-5071
- **Mailing address phone:** (913) 772-4334
- **Mailing address fax:** (913) 772-0851

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | 4672 | KS | Yes |

## Other

- **Enumeration date:** 02/23/2006
- **Last updated:** 08/22/2020