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General NPI Number Information
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NPI Number | 1447602792
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Entity Type | Organization
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Legal Business Name | KANSAS DENTAL ELEMENTS LLC
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Dates
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Enumeration Date | 07/11/2016
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Last Update Date | 07/11/2016
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Provider Practice Location Address
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Address Line | 11912 SHAWNEE MISSION PKWY
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City | SHAWNEE
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State | KS
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Zip | 66216-1865
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Country | US
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Telephone | 913-383-0440
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Fax |
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Provider Business Mailing Address
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Address Line | 7400 W 130TH ST SUITE 320
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City | OVERLAND PARK
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State | KS
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Zip | 66213-2715
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Country | US
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Telephone | 785-554-8910
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | JACOB MEGGISON
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Credential | DDS
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Telephone | 785-554-8910
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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 | 60737
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License Number State | KS
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