Individual
JACK G OKERSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, PA
Contact information
Practice address
4026 W. 83RD ST, PRAIRIE VILLAGE, KS 66208
(913) 469-9191
(913) 451-2251
Mailing address
11940 QUIVIRA RD, OVERLAND PARK, KS 66213
(913) 469-9191
(913) 451-2251
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
KS52000
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
284782
—
KS
Enumeration date
08/31/2006
Last updated
12/19/2013
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