Provider Demographics
NPI:1992807564
Name:WAITLEY, NORMAN (DDS)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:WAITLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10985 CODY ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1219
Mailing Address - Country:US
Mailing Address - Phone:913-339-9437
Mailing Address - Fax:913-339-9538
Practice Address - Street 1:10985 CODY ST
Practice Address - Street 2:SUITE 110
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1219
Practice Address - Country:US
Practice Address - Phone:913-339-9437
Practice Address - Fax:913-339-9538
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4877207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2508767Medicaid
KS100084500BMedicaid
KS100084500BMedicaid
KSE78D627Medicare ID - Type UnspecifiedKC MEDICARE
MO2508767Medicaid