Provider Demographics
NPI:1336420314
Name:SMILES OF KANSAS CITY DENTAL CENTER, P.A.
Entity type:Organization
Organization Name:SMILES OF KANSAS CITY DENTAL CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:LAREE
Authorized Official - Last Name:BERKVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-254-1300
Mailing Address - Street 1:10127 CHERRY #E
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66220
Mailing Address - Country:US
Mailing Address - Phone:913-254-1300
Mailing Address - Fax:
Practice Address - Street 1:10127 CHERRY #E
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66220
Practice Address - Country:US
Practice Address - Phone:913-254-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS.603791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty