| NPI | 1558433946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSS S HEADLEY Owner 913-491-6874 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 6953) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 6953) |
| 1223G0001X Dentist, General Practice (Licence: KS 5389) | |
| 122300000X Dentist (Licence: KS 60571) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2014-06-10 |