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NPI Code Detail

MEDICARE: NOLAND ROAD DENTAL, LLC

MEDICARE: NOLAND ROAD DENTAL, 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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1871730952
Entity Type Code : Organization
Provider Name (Legal Business Name) : NOLAND ROAD DENTAL, LLC
Provider Business Mailing Address
First Line : 3908 S NOLAND RD
Second Line :
City : INDEPENDENCE
State : MO
Zip : 64055-3347
Country : US
Telephone Number : 816-461-2273
Fax Number :
Provider Business Practice Location Address
First Line : 3908 S NOLAND RD
Second Line :
City : INDEPENDENCE
State : MO
Zip : 64055-3347
Country : US
Telephone Number : 816-461-2273
Fax Number :
Authorized Official
Title or Position : PARTNER/OWNER
Name : DR. MATHEW H DRAPER
Credential : DDS
Telephone Number : 816-461-2273
Provider Enumeration Date : 01/12/2009
Last Update Date : 01/12/2009

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Directions to “NOLAND ROAD DENTAL, LLC ” Practice Location

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