| NPI | 1578632444 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES B INDIVERI President 816-229-1245 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 015196) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 6441) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 810) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KS 445) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-08-22 |