Provider Demographics
NPI:1366875718
Name:STALEY DENTAL ARTS, LLC
Entity type:Organization
Organization Name:STALEY DENTAL ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:MENDENHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-605-0034
Mailing Address - Street 1:506 NE 107TH STREET
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155
Mailing Address - Country:US
Mailing Address - Phone:816-605-0034
Mailing Address - Fax:816-817-1181
Practice Address - Street 1:506 NE 107TH STREET
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155
Practice Address - Country:US
Practice Address - Phone:816-605-0034
Practice Address - Fax:816-817-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty