Healthcare Provider Details

I. General information

NPI: 1013146547
Provider Name (Legal Business Name): KANSAS CITY KANSAS DENTAL PROFESSIONALS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 STATE AVE
KANSAS CITY KS
66101-2516
US

IV. Provider business mailing address

753 STATE AVE
KANSAS CITY KS
66101-2516
US

V. Phone/Fax

Practice location:
  • Phone: 913-321-4385
  • Fax:
Mailing address:
  • Phone: 913-321-4385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number60337
License Number StateKS

VIII. Authorized Official

Name: DR. CAROL J JONES
Title or Position: PRESIDENT
Credential: DDS
Phone: 913-321-4385