PERIODONTIST PA NPI 1104948959

NPI Information

  • NPI: 1104948959
  • Provider Name: PERIODONTIST PA
  • Classification: Dentist - 1223P0300X
  • Specialization: Periodontics
  • Entity Type: Organization
  • Address: 10870 BENSON ST
    BLDG. 21 SUITE 2100
    OVERLAND PARK, KS
    ZIP 66210
  • Phone: (913) 451-6158

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NPI Details

PERIODONTIST PA is a periodontics dentist in Overland Park, KS. The provider is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. PERIODONTIST PA NPI is 1104948959. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

10870 BENSON ST
BLDG. 21 SUITE 2100
OVERLAND PARK, KS
ZIP 66210-502
Phone: (913) 451-6158
Fax: (913) 451-9463

The provider's authorized official is Stanley L Wint .
The authorized official title is President and has the following contact phone number (913) 451-6158.

The enumeration date for this NPI number is 4/4/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223P0300XDentistPeriodontics5544KANSASYes

What is NPI?

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This page was last updated on: 11/21/2025

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