| NPI | 1215034442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE C ELLSWORTH Office Manager 913-782-1420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KS 5361) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2015-10-19 |