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General NPI Number Information
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NPI Number | 1730365529
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Entity Type | Organization
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Legal Business Name | GLADSTONE FAMILY DENTISTRY L.L.C.
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Dates
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Enumeration Date | 01/11/2008
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Last Update Date | 01/11/2008
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Provider Practice Location Address
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Address Line | 6301 N OAK TRFY SUITE 202
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City | GLADSTONE
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State | MO
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Zip | 64118-4705
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Country | US
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Telephone | 816-452-2420
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Fax | 816-777-0836
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Provider Business Mailing Address
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Address Line | 6301 N OAK TRFY SUITE 202
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City | GLADSTONE
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State | MO
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Zip | 64118-4705
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Country | US
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Telephone | 816-452-2420
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Fax | 816-777-0836
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DEE HEISKELL
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Credential |
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Telephone | 816-452-2420
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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 | 011945
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License Number State | MO
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