Healthcare Provider Details

I. General information

NPI: 1093633422
Provider Name (Legal Business Name): MISSION DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5437 JOHNSON DR
MISSION KS
66205-2912
US

IV. Provider business mailing address

5437 JOHNSON DR
MISSION KS
66205-2912
US

V. Phone/Fax

Practice location:
  • Phone: 913-379-2017
  • Fax: 913-318-6203
Mailing address:
  • Phone: 913-379-2017
  • Fax: 913-318-6203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD SHAMIEH
Title or Position: OWNER
Credential: DDS
Phone: 913-379-2017