Healthcare Provider Details

I. General information

NPI: 1114592938
Provider Name (Legal Business Name): KAW VALLEY FAMILY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10601 KAW DR
EDWARDSVILLE KS
66111-1130
US

IV. Provider business mailing address

10601 KAW DR
EDWARDSVILLE KS
66111-1130
US

V. Phone/Fax

Practice location:
  • Phone: 913-441-3373
  • Fax:
Mailing address:
  • Phone: 913-441-3373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN MCKNIGHT
Title or Position: OWNER
Credential: DDS
Phone: 913-290-0014