Healthcare Provider Details

I. General information

NPI: 1265188080
Provider Name (Legal Business Name): WESTWOOD AESTHETIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4742 RAINBOW BLVD
WESTWOOD KS
66205-1835
US

IV. Provider business mailing address

655 R D MIZE RD
GRAIN VALLEY MO
64029-8542
US

V. Phone/Fax

Practice location:
  • Phone: 913-766-1756
  • Fax:
Mailing address:
  • Phone: 816-229-4560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL ROME
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 816-714-4990