# SHAWNEE DENTAL GROUP, PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Shawnee Modern Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871987545
- **Authorized official:** DR. PARDEEP GILL DDS (OWNER)
- **Authorized official phone:** (913) 631-0866

## Contact information

- **Practice address:** 15834 SHAWNEE MISSION PKWY, SHAWNEE, KS 66217-9326
- **Practice address phone:** (913) 631-0866
- **Practice address fax:** (913) 631-0865
- **Mailing address:** PO BOX 920050, DALLAS, TX 75392-0050
- **Mailing address phone:** (714) 845-8890
- **Mailing address fax:** (949) 474-1495

## Taxonomy

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

## Other

- **Enumeration date:** 03/20/2015
- **Last updated:** 05/11/2022