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General NPI Number Information
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NPI Number | 1649593039
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Entity Type | Individual
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Provider Name | JAMES B. INDIVERI D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/12/2010
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Last Update Date | 03/12/2010
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 810ORTHO
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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 | 015196DENTAL
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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 | 445ORTHO
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 6441DENTAL
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License Number State | KS
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