MEDICARE: GREEN HILLS DENTAL KC, LLC

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	122300000X	Dentist	2004013324	MO

General Provider Information

NPI Number	:	1750836292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN HILLS DENTAL KC, LLC

Provider Business Mailing Address
First Line	:	8530 N GREEN HILLS RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64154-1403
Country	:	US
Telephone Number	:	816-587-5555
Fax Number	:	816-587-0552

Provider Business Practice Location Address
First Line	:	8530 N GREEN HILLS RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64154-1403
Country	:	US
Telephone Number	:	816-587-5555
Fax Number	:	816-587-0552

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	ROBERT K. KLEIN
Credential	:	DDS
Telephone Number	:	816-587-5555

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	08/24/2016

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