1740255777 NPI number — MRS. LISA A THURLOW DDS

Table of content: MRS. LISA A THURLOW DDS (NPI 1740255777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740255777 NPI number — MRS. LISA A THURLOW DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THURLOW
Provider First Name:
LISA
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
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:
NOVAK
Provider Other First Name:
LISA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740255777
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:
5329 W 94TH TERRACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAWNEE MISSION
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-341-7440
Provider Business Mailing Address Fax Number:
913-341-6220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5329 W 94TH TERRACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHAWNEE MISSION
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-341-7440
Provider Business Practice Location Address Fax Number:
913-341-6220
Provider Enumeration Date:
02/22/2006

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:  6925 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 449032 . This is a "BCBS KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 21597040 . This is a "BCBS KC" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 889089 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".