Basic Information
| Provider Information | |||||||||
| NPI: | 1710625405 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAUS | ||||||||
| FirstName: | MITCHELL | ||||||||
| MiddleName: | RYAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18422 N 78TH DR | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853088219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232624878 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 17081 W GREENWAY RD STE 120 | ||||||||
| Address2: | |||||||||
| City: | SURPRISE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853889612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235468400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2022 | ||||||||
| LastUpdateDate: | 05/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | D011367 | AZ | Y | Dental Providers | Dentist |
No ID Information.