Organization
WAKARUSA ORAL SURGERY, LC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP CHARLES GAUS JR. DDS (MANAGER/MEMBER)
(785) 856-6010
Entity
Organization
Contact information
Practice address
4901 LEGENDS DR, LAWRENCE, KS 66049-5800
(785) 856-6010
Mailing address
4901 LEGENDS DR, LAWRENCE, KS 66049-5800
(785) 856-6010
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
6706
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100224610B
—
KS
Enumeration date
07/17/2009
Last updated
07/17/2009
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