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General NPI Number Information
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NPI Number | 1801961164
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Entity Type | Organization
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Legal Business Name | DENTISTRY ON DOUGLAS STREET LLC
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 103 NE DOUGLAS STREET
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City | LEES SUMMIT
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State | MO
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Zip | 64063-2037
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Country | US
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Telephone | 816-524-1337
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Fax | 816-525-7640
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Provider Business Mailing Address
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Address Line | 103 NE DOUGLAS STREET
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City | LEES SUMMIT
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State | MO
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Zip | 64063-2037
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Country | US
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Telephone | 816-524-1337
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Fax | 816-525-7640
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Authorized Official
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Title or Position | PARTNER DENTIST
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Name | DR. SCOTT A DEMPSEY
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Credential | DDS
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Telephone | 816-524-1337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE015418
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License Number State | MO
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