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General NPI Number Information
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NPI Number | 1801277165
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Entity Type | Organization
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Legal Business Name | EMBRACEABLE, AZ LLC
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Dates
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Enumeration Date | 06/12/2015
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Last Update Date | 06/12/2015
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Provider Practice Location Address
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Address Line | 8700 SANTA FE DR
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City | OVERLAND PARK
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State | KS
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Zip | 66212-3654
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Country | US
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Telephone | 913-416-4661
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Fax |
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Provider Business Mailing Address
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Address Line | 8700 SANTA FE DR
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City | OVERLAND PARK
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State | KS
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Zip | 66212-3654
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Country | US
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Telephone | 913-416-4661
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. MATTHEW NOYCE
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Credential | DDS, MS
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Telephone | 913-416-4661
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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 | 61100
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License Number State | KS
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