Healthcare Provider Details

I. General information

NPI: 1861901639
Provider Name (Legal Business Name): PHYE FAMILY DENTISTRY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 07/21/2022
Certification Date: 07/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S. CLAIRBORNE SUITE A
OLATHE KS
66062
US

IV. Provider business mailing address

401 S CLAIRBORNE RD STE A
OLATHE KS
66062-1735
US

V. Phone/Fax

Practice location:
  • Phone: 913-782-2231
  • Fax: 913-782-2246
Mailing address:
  • Phone: 913-782-2231
  • Fax: 913-782-2246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7126
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number60308
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number60739
License Number StateKS
# 5
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6899
License Number StateKS

VIII. Authorized Official

Name: MRS. KIMBERLY ANN RESZ
Title or Position: OFFICE ADMINISTRATOR
Credential: RDH, BS
Phone: 913-782-2231