Provider Demographics
NPI:1316289424
Name:DUSTIN K. MACE, L.L.C.
Entity type:Organization
Organization Name:DUSTIN K. MACE, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MACE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-561-6150
Mailing Address - Street 1:801 W 47TH ST
Mailing Address - Street 2:SUITE 408
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-1377
Mailing Address - Country:US
Mailing Address - Phone:816-561-6150
Mailing Address - Fax:
Practice Address - Street 1:801 W 47TH ST
Practice Address - Street 2:SUITE 408
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1377
Practice Address - Country:US
Practice Address - Phone:816-561-6150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty