Healthcare Provider Details

I. General information

NPI: 1801961164
Provider Name (Legal Business Name): DENTISTRY ON DOUGLAS STREET LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 NE DOUGLAS STREET
LEES SUMMIT MO
64063-2037
US

IV. Provider business mailing address

103 NE DOUGLAS STREET
LEES SUMMIT MO
64063-2037
US

V. Phone/Fax

Practice location:
  • Phone: 816-524-1337
  • Fax: 816-525-7640
Mailing address:
  • Phone: 816-524-1337
  • Fax: 816-525-7640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE015418
License Number StateMO

VIII. Authorized Official

Name: DR. SCOTT A DEMPSEY
Title or Position: PARTNER DENTIST
Credential: DDS
Phone: 816-524-1337