Provider Demographics
NPI:1588300768
Name:PUDLOWSKI, ANNE MARIE MCCOY (DDS)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE MCCOY
Last Name:PUDLOWSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E 68TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-2457
Mailing Address - Country:US
Mailing Address - Phone:314-299-8652
Mailing Address - Fax:
Practice Address - Street 1:16103 W 135TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1516
Practice Address - Country:US
Practice Address - Phone:913-829-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021048523122300000X
KS61950122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist