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General NPI Number Information
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NPI Number | 1356689376
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Entity Type | Organization
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Legal Business Name | CARL H. DAHLQUIST D.D.S.,LLC
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Dates
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Enumeration Date | 01/25/2013
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Last Update Date | 01/25/2013
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Provider Practice Location Address
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Address Line | 1508 N.W. MOCK AVE. STE A
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City | BLUE SPRINGS
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State | MO
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Zip | 64015
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Country | US
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Telephone | 816-228-7176
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Fax |
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Provider Business Mailing Address
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Address Line | 1508 N.W. MOCK AVE. STE A
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City | BLUE SPRINGS
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State | MO
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Zip | 64015
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Country | US
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Telephone | 816-228-7176
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Fax | 816-224-9555
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. NANCY D. PORTER
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Credential |
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Telephone | 816-228-7176
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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 | 013940
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License Number State | MO
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