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General NPI Number Information
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NPI Number | 1578632444
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Entity Type | Organization
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Legal Business Name | JAMES B INDIVERI DMD PC
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 300 NW R D MIZE ROAD
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City | BLUE SPRINGS
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State | MO
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Zip | 64014
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Country | US
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Telephone | 816-229-1245
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Fax | 816-229-7555
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Provider Business Mailing Address
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Address Line | 300 NW R D MIZE ROAD
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City | BLUE SPRINGS
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State | MO
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Zip | 64014
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Country | US
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Telephone | 816-229-1245
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Fax | 816-229-7555
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES B INDIVERI
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Credential | DMD PC
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Telephone | 816-229-1245
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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 | 015196
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 810
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 445
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6441
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License Number State | KS
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