Individual
JERRY R NOSSAMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
831 VERMONT ST, LAWRENCE, KS 66044-2665
(785) 843-6060
(785) 843-4335
Mailing address
1116 WEST HILLS PKWY, LAWRENCE, KS 66044
(785) 842-7181
(785) 843-4335
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4549
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116938
BCBS OF KS
KS
01
—
36600015
BCBS OF KC
KS
Enumeration date
06/28/2006
Last updated
07/08/2007
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