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General NPI Number Information
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NPI Number | 1215362066
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Entity Type | Organization
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Legal Business Name | MY DENTIST WESTERN, KC, PA
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Dates
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Enumeration Date | 09/12/2013
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Last Update Date | 09/12/2013
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Provider Practice Location Address
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Address Line | 7848 STATE AVE
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City | KANSAS CITY
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State | KS
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Zip | 66112-2417
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Country | US
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Telephone | 913-299-1001
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Fax | 913-299-1002
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Provider Business Mailing Address
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Address Line | PO BOX 702620
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City | TULSA
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State | OK
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Zip | 74170-2620
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Country | US
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Telephone | 405-286-9024
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Fax | 405-286-9088
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Authorized Official
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Title or Position | CHIEF DENTAL DIRECTOR
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Name | JENNIFER CHAMBERS
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Credential | DDS
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Telephone | 405-753-1237
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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 |
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License Number State |
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