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General NPI Number Information
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NPI Number | 1194001370
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Entity Type | Organization
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Legal Business Name | AFFORDABLE DENTAL OF OLATHE, LLC
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 920 6TH AVE MEDICAL ARTS BLDG, SUITE 101
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City | LEAVENWORTH
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State | KS
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Zip | 66048-3225
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Country | US
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Telephone | 913-682-2595
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Fax | 913-682-2595
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Provider Business Mailing Address
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Address Line | 401 S CLAIRBORNE RD SUITE 201
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City | OLATHE
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State | KS
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Zip | 66062-1735
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Country | US
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Telephone | 913-839-1792
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Fax | 913-839-1792
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. M CONRAD JOURNEE
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Credential | DDS
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Telephone | 816-392-3112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7100
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 60842
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License Number State | KS
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