Healthcare Provider Details

I. General information

NPI: 1306428362
Provider Name (Legal Business Name): MIDTOWN DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 MAIN ST STE 100A
KANSAS CITY MO
64111-1946
US

IV. Provider business mailing address

106 E 30TH ST
KANSAS CITY MO
64108-3211
US

V. Phone/Fax

Practice location:
  • Phone: 402-580-2674
  • Fax:
Mailing address:
  • Phone: 816-643-3400
  • 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 NGUYEN
Title or Position: DENTIST
Credential: DDS
Phone: 402-580-2764