Organization
FALES PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KONNIE C. LUTZ (PRACTICE ADMINISTRATOR)
(913) 782-2207
Entity
Organization
Contact information
Practice address
13496 S ARAPAHO DR, OLATHE, KS 66062-1553
(913) 782-2207
(913) 489-0028
Mailing address
13496 S ARAPAHO DR, OLATHE, KS 66062-1553
(913) 782-2207
(913) 489-0028
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
5859
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100222530C
—
KS
05
—
405694209
—
MO
Enumeration date
01/18/2013
Last updated
01/18/2013
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