MEDICARE: SWEET TOOTH ST. JOSEPH ORTHODONTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1457295164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWEET TOOTH ST. JOSEPH ORTHODONTICS

Provider Business Mailing Address
First Line	:	6750 W 93RD ST STE 110
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66212-1465
Country	:	US
Telephone Number	:	913-276-3809
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 S BELT HWY
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-3421
Country	:	US
Telephone Number	:	913-276-3809
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WAYNE DOBBINS
Credential	:
Telephone Number	:	913-276-3809

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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