1295713311 NPI number — DR. PATRICIA LEE ROTH-DOHNALEK DDS

Table of content: DR. PATRICIA LEE ROTH-DOHNALEK DDS (NPI 1295713311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295713311 NPI number — DR. PATRICIA LEE ROTH-DOHNALEK DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROTH-DOHNALEK
Provider First Name:
PATRICIA
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROTH
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1295713311
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
608 SW FORESTPARK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEES SUMMIT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64081-2133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-524-8252
Provider Business Mailing Address Fax Number:
816-525-7225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
521 SE 2ND ST
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
LEES SUMMIT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64063-2646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-525-7155
Provider Business Practice Location Address Fax Number:
816-525-7225
Provider Enumeration Date:
01/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  014686 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com