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General NPI Number Information
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NPI Number | 1811571896
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Entity Type | Organization
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Legal Business Name | VILLAGE COMPLETE DENTISTRY, LLC
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Dates
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Enumeration Date | 05/06/2021
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Last Update Date | 05/06/2021
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Provider Practice Location Address
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Address Line | 4121 W 83RD ST STE 137
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-5323
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Country | US
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Telephone | 913-381-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 4121 W 83RD ST STE 137
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-5323
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Country | US
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Telephone | 913-381-4700
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Fax |
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Authorized Official
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Title or Position | MEMBER/DENTIST
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Name | DR. BLAIR EDGINGTON HANNAMAN
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Credential | DDS
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Telephone | 913-381-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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