Healthcare Provider Details

I. General information

NPI: 1124826656
Provider Name (Legal Business Name): SWEET TOOTH SUMMIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 SE 291 HWY
LEES SUMMIT MO
64063-4302
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 913-276-3809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

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