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NPI Code Detail

MEDICARE: PEDIATRIC DENTAL SPECIALISTS, PA

MEDICARE: PEDIATRIC DENTAL SPECIALISTS, 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
1261QD0000XDental Clinic/Center015672MO

General Provider Information

NPI Number : 1083943963
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC DENTAL SPECIALISTS, PA
Provider Business Mailing Address
First Line : 209 NE BARRY RD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64155-2721
Country : US
Telephone Number : 816-741-8881
Fax Number : 816-741-0585
Provider Business Practice Location Address
First Line : 209 NE BARRY RD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64155-2721
Country : US
Telephone Number : 816-741-8881
Fax Number : 816-741-0585
Authorized Official
Title or Position : OFFICE MANAGER
Name : ALICE WEBSTER
Credential :
Telephone Number : 816-741-8881
Provider Enumeration Date : 12/23/2009
Last Update Date : 12/23/2009

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