OrganizationActive
Leavenworth Oral & Maxillofacial Surgeons PA
NPI 1609841493 · Oral and Maxillofacial Pathology Dentistry · Leavenworth, KS
Provider details
- NPI number
- 1609841493
- Entity type
- Organization
- Primary specialty
- Oral and Maxillofacial Pathology DentistryDental Providers
- Organization subpart
- No
- Authorized official
- Larry Evans, President(913) 772-4334
- License
- 4672 (KS)
Specialties & taxonomies
Dental Providers
Practice location
3550 S 4th St
Suite 240
Leavenworth, KS 66048-5071
Phone: (913) 772-4334
Fax: (913) 772-0851
Approximate (ZIP-level) locationGet directions
Mailing address
3550 S 4th St
Leavenworth, KS 66048-5071
Registry dates
- Enumerated
- 2006-02-23
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.