=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750188652
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAYLEE BERGMAN ORTHODONTICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2025
-----------------------------------------------------
Last Update Date | 02/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4425 INDIAN CREEK PKWY
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66207-4013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-708-0860
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4425 INDIAN CREEK PKWY
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66207-4013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-708-0860
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORTHODONTIST
-----------------------------------------------------
Name | DR. KAYLEE BERGMAN
-----------------------------------------------------
Credential | DDS, MS
-----------------------------------------------------
Telephone | 913-708-0860
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------