MEDICARE: DR. MICHAEL CONRAD JOURNEE D.D.S.

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	60842	KS
2	1223G0001X	General Practice Dentistry	015901	MO

General Provider Information

NPI Number	:	1689892580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL CONRAD JOURNEE D.D.S.

Provider Business Mailing Address
First Line	:	4910 NE 81ST ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-8400
Country	:	US
Telephone Number	:	816-420-9070
Fax Number	:

Provider Business Practice Location Address
First Line	:	4910 NE 81ST ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-8400
Country	:	US
Telephone Number	:	816-420-9070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	03/17/2018

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