Individual
DR. EDWARD D. DALLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
5000 W 95TH ST STE 300, PRAIRIE VILLAGE, KS 66207
(913) 649-0310
Mailing address
5000 W 95TH ST STE 300, PRAIRIE VILLAGE, KS 66207-3300
(913) 649-0310
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12689
KS
332B00000X
Durable Medical Equipment & Medical Supplies
12689
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06778074
BLUE CROSS BLUE SHEILD KC
MO
Enumeration date
03/07/2007
Last updated
02/20/2019
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