| NPI | 1164599452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH DAVID JOHNSON General Dentist Owner 816-781-7571 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 14182) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2020-08-22 |