Healthcare Provider Details

I. General information

NPI: 1891629309
Provider Name (Legal Business Name): LILLIAN NACKE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10925 ANTIOCH RD STE 201
OVERLAND PARK KS
66210-2119
US

IV. Provider business mailing address

10925 ANTIOCH RD STE 201
OVERLAND PARK KS
66210-2119
US

V. Phone/Fax

Practice location:
  • Phone: 913-491-1200
  • Fax:
Mailing address:
  • Phone: 913-491-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2026022104
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number62365
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: