Healthcare Provider Details

I. General information

NPI: 1780490185
Provider Name (Legal Business Name): SWEET TOOTH GRANDVIEW ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11908 BLUE RIDGE EXT
GRANDVIEW MO
64030-1160
US

IV. Provider business mailing address

6600 COLLEGE BLVD STE 125
OVERLAND PARK KS
66211-1522
US

V. Phone/Fax

Practice location:
  • Phone: 816-355-8068
  • Fax: 816-205-6867
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WAYNE DOBBINS
Title or Position: OWNER
Credential: DDS
Phone: 913-276-3809