| NPI | 1821248162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY WHEELER Credentialing COO Rdinator 913-800-6952 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2017-04-12 |