| NPI | 1942746896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN SHEWANICK Member 816-454-1313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: MO 2009016386) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental (Licence: MO 2014022711) |
| 261QD0000X Clinic/Center Dental (Licence: MO 2014018762) | |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2017-01-17 |