| NPI | 1144207705 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENELL STUMP Director, Licensing & Credentialing 913-287-7977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2005-12-26 |
| Last Update Date | 2015-03-26 |