Basic Information
| Provider Information | |||||||||
| NPI: | 1306840012 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANDAR | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 6TH AVE | ||||||||
| Address2: | STE 320 | ||||||||
| City: | LEAVENWORTH | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660483248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136516565 | ||||||||
| FaxNumber: | 9137728806 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 6TH AVE | ||||||||
| Address2: | STE. 320 | ||||||||
| City: | LEAVENWORTH | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660483222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136516565 | ||||||||
| FaxNumber: | 9136512087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 02/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35072819 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 04-30685 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.