Provider Demographics
NPI:1912530478
Name:KANSAS CITY PEDIATRIC DENTISTRY LLC
Entity type:Organization
Organization Name:KANSAS CITY PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-622-2000
Mailing Address - Street 1:3801 SOUTHWEST TRFY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2902
Mailing Address - Country:US
Mailing Address - Phone:816-622-2000
Mailing Address - Fax:816-298-9214
Practice Address - Street 1:3801 SOUTHWEST TRFY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2902
Practice Address - Country:US
Practice Address - Phone:816-622-2000
Practice Address - Fax:816-298-9214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty