=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861901639
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYE FAMILY DENTISTRY, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 S. CLAIRBORNE SUITE A
-----------------------------------------------------
City | OLATHE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-782-2231
-----------------------------------------------------
Fax | 913-782-2246
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 S CLAIRBORNE RD STE A
-----------------------------------------------------
City | OLATHE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66062-1735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-782-2231
-----------------------------------------------------
Fax | 913-782-2246
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE ADMINISTRATOR
-----------------------------------------------------
Name | MRS. KIMBERLY ANN RESZ
-----------------------------------------------------
Credential | RDH, BS
-----------------------------------------------------
Telephone | 913-782-2231
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 7126
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 60308
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 60739
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 6899
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------