Healthcare Provider Details

I. General information

NPI: 1477366185
Provider Name (Legal Business Name): SWEET TOOTH INDEPENDENCE ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 S NOLAND RD STE 140
INDEPENDENCE MO
64050-3973
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 816-205-4046
  • Fax: 816-205-4056
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

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