MEDICARE: COSMETIC AND IMPLANT DENTISTRY OF WESTPORT

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1649953613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COSMETIC AND IMPLANT DENTISTRY OF WESTPORT

Provider Business Mailing Address
First Line	:	638 W 39TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2910
Country	:	US
Telephone Number	:	816-388-0985
Fax Number	:

Provider Business Practice Location Address
First Line	:	638 W 39TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2910
Country	:	US
Telephone Number	:	816-388-0985
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	TATE ANDREWS
Credential	:
Telephone Number	:	816-388-0985

Provider Enumeration Date	:	08/08/2023
Last Update Date	:	08/08/2023

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Directions to “COSMETIC AND IMPLANT DENTISTRY OF WESTPORT ” Practice Location

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