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General NPI Number Information
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NPI Number | 1285465120
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Entity Type | Organization
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Legal Business Name | SOUTHTOWN FAMILY DENTAL LLC
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Dates
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Enumeration Date | 08/12/2024
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 19 E GREGORY BLVD
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City | KANSAS CITY
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State | MO
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Zip | 64114-1117
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Country | US
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Telephone | 816-603-1737
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Fax | 816-652-0808
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Provider Business Mailing Address
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Address Line | 19 E GREGORY BLVD
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City | KANSAS CITY
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State | MO
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Zip | 64114-1117
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Country | US
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Telephone | 573-201-9262
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. RICHARD S CAMPOS
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Credential | DMD, MS
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Telephone | 816-603-1737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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