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General NPI Number Information
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NPI Number | 1952617557
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Entity Type | Organization
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Legal Business Name | KATHI J. MATTHES D.D.S. , P.C.
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Dates
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Enumeration Date | 08/20/2010
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Last Update Date | 08/20/2010
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Provider Practice Location Address
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Address Line | 517 SW 3RD ST
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City | LEES SUMMIT
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State | MO
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Zip | 64063-2258
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Country | US
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Telephone | 816-524-3734
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Fax | 816-524-9211
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Provider Business Mailing Address
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Address Line | 517 SW 3RD ST
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City | LEES SUMMIT
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State | MO
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Zip | 64063-2258
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Country | US
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Telephone | 816-524-3734
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Fax | 816-524-9211
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Authorized Official
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Title or Position | DENTIST
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Name | KATHI JO MATTHES
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Credential | D.D.S.
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Telephone | 816-524-3734
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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 | 016020
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License Number State | MO
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