Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 2021028192 | MO |
NPI | 1114696671 |
---|---|
Provider Name | Dr. Therin Jo Baum |
First Address | Kansas City, MO 64108-3496 |
Second Address | Kansas City, MO 64108-2716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2021 |
Last Update Date | 08/09/2021 |