Organization
LEAVENWORTH ORAL & MAXILLOFACIAL SURGEONS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY D EVANS D.D.S. (PRESIDENT)
(913) 772-4334
Entity
Organization
Contact information
Practice address
3550 S 4TH ST, SUITE 240, LEAVENWORTH, KS 66048-5071
(913) 772-4334
(913) 772-0851
Mailing address
3550 S 4TH ST, SUITE 240, LEAVENWORTH, KS 66048-5071
(913) 772-4334
(913) 772-0851
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
4672
KS
Other
Enumeration date
02/23/2006
Last updated
08/22/2020
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