| NPI | 1639562473 |
|---|---|
| Doing Business As | IMMEDIADENT |
| Entity Type | Organization |
| Authorized Contact | MONICA L LONG Manager Of Provider Credentialing 913-428-1686 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2015-03-17 |
| Last Update Date | 2017-05-01 |