Provider Demographics
NPI:1336210962
Name:BLUE VALLEY DENTAL CARE PA
Entity type:Organization
Organization Name:BLUE VALLEY DENTAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:O'KEEFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-681-5300
Mailing Address - Street 1:7916 W 151ST ST
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2118
Mailing Address - Country:US
Mailing Address - Phone:913-681-5300
Mailing Address - Fax:913-681-5053
Practice Address - Street 1:7916 W 151ST ST
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:KS
Practice Address - Zip Code:66223-2118
Practice Address - Country:US
Practice Address - Phone:913-681-5300
Practice Address - Fax:913-681-5053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS71631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty