Individual
MARISSA BERGTHOLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
7701 W 119TH ST, OVERLAND PARK, KS 66213-1103
(913) 529-5999
(913) 529-5995
Mailing address
7701 W 119TH ST, OVERLAND PARK, KS 66213-1103
(913) 529-5999
(913) 529-5995
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
2024026317
MO
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
62193
KS
Other
Enumeration date
04/26/2018
Last updated
07/11/2024
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