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General NPI Number Information
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NPI Number | 1053655274
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Entity Type | Organization
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Legal Business Name | TONGANOXIE FAMILY DENTISTRY
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 6725 N PARK AVE
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City | GLADSTONE
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State | MO
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Zip | 64118-3783
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Country | US
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Telephone | 816-813-7917
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Fax |
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Provider Business Mailing Address
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Address Line | 766 NORTHSTAR COURT
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City | TONGANOXIE
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State | KS
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Zip | 66086
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DAVID H JAEGER
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Credential | DDS
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Telephone | 816-813-7917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 60803
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License Number State | KS
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