MEDICARE: KANSAS CITY KANSAS DENTAL PROFESSIONALS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	60337	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013146547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANSAS CITY KANSAS DENTAL PROFESSIONALS PA

Provider Business Mailing Address
First Line	:	753 STATE AVE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66101-2516
Country	:	US
Telephone Number	:	913-321-4385
Fax Number	:

Provider Business Practice Location Address
First Line	:	753 STATE AVE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66101-2516
Country	:	US
Telephone Number	:	913-321-4385
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CAROL J JONES
Credential	:	DDS
Telephone Number	:	913-321-4385

Provider Enumeration Date	:	07/06/2009
Last Update Date	:	07/06/2009

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Directions to “KANSAS CITY KANSAS DENTAL PROFESSIONALS PA ” Practice Location

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