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General NPI Number Information
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NPI Number | 1548378128
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Entity Type | Organization
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Legal Business Name | ALTENBURG DENTAL GROUP, DDS, P.C.
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5571 NW BARRY RD
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City | KANSAS CITY
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State | MO
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Zip | 64154-1408
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Country | US
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Telephone | 816-587-0600
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Fax | 816-587-7662
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Provider Business Mailing Address
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Address Line | 5571 NW BARRY RD
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City | KANSAS CITY
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State | MO
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Zip | 64154-1408
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Country | US
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Telephone | 816-587-0600
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Fax | 816-587-7662
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY J ALTENBURG
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Credential | DDS
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Telephone | 816-587-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 013242
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License Number State | MO
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