Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 60941 | KS |
NPI | 1023244894 |
---|---|
Provider Name | Dr. Barbara Opsahl Schupp |
First Address | Lawrence, KS 66044-1393 |
Second Address | Lawrence, KS 66044-1393 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2009 |
Last Update Date | 20/05/2014 |