Provider Demographics
NPI:1992903140
Name:WESTPORT PLAZA DENTAL ASSOCIATES
Entity type:Organization
Organization Name:WESTPORT PLAZA DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALDRON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-561-6150
Mailing Address - Street 1:801 W 47TH ST
Mailing Address - Street 2:408
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:816-561-6738
Practice Address - Street 1:801 W 47TH ST
Practice Address - Street 2:408
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:816-561-6738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental