Healthcare Provider Details

I. General information

NPI: 1730192469
Provider Name (Legal Business Name): STARTING POINT DENTAL SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14465 METCALF AVE
OVERLAND PARK KS
66223-2990
US

IV. Provider business mailing address

14465 METCALF AVE
OVERLAND PARK KS
66223-2990
US

V. Phone/Fax

Practice location:
  • Phone: 913-553-2492
  • Fax: 913-553-2493
Mailing address:
  • Phone: 913-553-2492
  • Fax: 913-553-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number60313
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number60313
License Number StateKS

VIII. Authorized Official

Name: DR. JOHN PAUL ROTH
Title or Position: PRESIDENT OWNER
Credential: DDS
Phone: 913-553-2492