Provider Demographics
NPI:1447246558
Name:LARRY D SHELDON DDS CHARTERED
Entity type:Organization
Organization Name:LARRY D SHELDON DDS CHARTERED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:SHELDON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-782-7580
Mailing Address - Street 1:125 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-3428
Mailing Address - Country:US
Mailing Address - Phone:913-782-7580
Mailing Address - Fax:913-782-0122
Practice Address - Street 1:125 E PARK ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3428
Practice Address - Country:US
Practice Address - Phone:913-782-7580
Practice Address - Fax:913-782-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO08634017OtherBCBS KC
KS450463OtherBCBS KS
974909OtherUNITED CONCORDIA