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General NPI Number Information
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NPI Number | 1982926804
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Entity Type | Organization
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Legal Business Name | CORINTH DENTAL CARE, LLC
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Dates
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Enumeration Date | 02/19/2010
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Last Update Date | 02/19/2010
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Provider Practice Location Address
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Address Line | 3700 W 83RD ST SUITE 217
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-5120
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Country | US
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Telephone | 913-341-9600
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Fax | 913-341-6328
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Provider Business Mailing Address
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Address Line | 3700 W 83RD ST SUITE 217
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-5120
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Country | US
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Telephone | 913-341-9600
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. TRICIA MARIE CANZONERE
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Credential | DDS
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Telephone | 913-341-9600
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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 | 60394
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License Number State | KS
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