Provider Demographics
NPI:1265273700
Name:MEHLIN, NICHOLAS J (DDS)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:J
Last Name:MEHLIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:MEHLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1300 MEADOW LAKE TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1626
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11551 GRANADA ST STE 200
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1444
Practice Address - Country:US
Practice Address - Phone:913-642-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS621491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice