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General NPI Number Information
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NPI Number | 1790940872
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Entity Type | Organization
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Legal Business Name | ANTIOCH DENTAL INC
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Dates
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Enumeration Date | 07/28/2008
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Last Update Date | 06/13/2013
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Provider Practice Location Address
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Address Line | 8650 W 95TH ST STE 2
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City | OVERLAND PARK
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State | KS
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Zip | 66212-3246
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Country | US
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Telephone | 913-642-0031
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Fax | 913-642-2188
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Provider Business Mailing Address
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Address Line | 8650 W 95TH ST STE 2
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City | OVERLAND PARK
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State | KS
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Zip | 66212-3246
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Country | US
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Telephone | 913-642-0031
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Fax | 913-642-2188
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Authorized Official
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Title or Position | PRESIDENT
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Name | IRWIN N. BOE JR.
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Credential | DDS
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Telephone | 913-642-0031
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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 | 60303
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License Number State | KS
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