MEDICARE: HEARTLAND FAMILY DENTISTRY INC

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	1223G0001X	General Practice Dentistry	015729	MO

General Provider Information

NPI Number	:	1063517290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND FAMILY DENTISTRY INC

Provider Business Mailing Address
First Line	:	8355 N CONGRESS AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64152-2041
Country	:	US
Telephone Number	:	816-587-9500
Fax Number	:	816-587-9501

Provider Business Practice Location Address
First Line	:	8355 N CONGRESS AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64152-2041
Country	:	US
Telephone Number	:	816-587-9500
Fax Number	:	816-587-9501

Authorized Official
Title or Position	:	DENTIST/PRESIDENT
Name	:	DR. SCOTT M NGUYEN
Credential	:	DDS
Telephone Number	:	816-587-9500

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	12/17/2020

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