Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 60062 | KS |
NPI | 1649254350 |
---|---|
Provider Name | Dr. Richard Larry Winburn |
First Address | Overland Park, KS 66212-5452 |
Second Address | Overland Park, KS 66212-5452 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 08/07/2007 |