Organization
DR. EDWARD D. DALLAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD D. DALLAM D.D.S. (OWNER)
(816) 373-8800
Entity
Organization
Contact information
Practice address
4437 S RIVER BLVD, INDEPENDENCE, MO 64055-4658
(816) 373-8800
(816) 373-2452
Mailing address
4437 S RIVER BLVD, INDEPENDENCE, MO 64055-4658
(816) 373-8800
(816) 373-2452
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
MO12689
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06778074
BLUE CROSS BLUE SHEILD KC
MO
Enumeration date
01/15/2007
Last updated
08/22/2020
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