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General NPI Number Information
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NPI Number | 1194072421
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Entity Type | Organization
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Legal Business Name | AMAZING SMILES OF KANSAS CITY, LLC
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 08/06/2012
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Provider Practice Location Address
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Address Line | 8915 STATE AVE
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City | KANSAS CITY
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State | KS
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Zip | 66112-1645
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Country | US
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Telephone | 913-788-7600
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Fax | 913-788-7601
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Provider Business Mailing Address
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Address Line | 8915 STATE AVE
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City | KANSAS CITY
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State | KS
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Zip | 66112-1645
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Country | US
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Telephone | 913-788-7600
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Fax | 913-788-7601
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | KELLY MCCRACKEN
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Credential | D.D.S.
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Telephone | 913-788-7600
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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 | 60811
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License Number State | KS
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