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4516 Broadway Unit 301 Kansas City MO 64111-3381 | |
| (573) 230-6862 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 4516 Broadway, Kansas City, Missouri |
| Authorized Official Name and Position | Peter Benjamin Mcclellan (OWNER DENTIST) |
| Authorized Official Contact | 5732306862 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
655 R D Mize Rd. Grain Valley MO 64029 Ph: (816) 229-4560 | 4516 Broadway Unit 301 Kansas City MO 64111-3381 Ph: (573) 230-6862 |
| NPI Number | 1972040699 |
|---|---|
| Provider Enumeration Date | 01/20/2017 |
| Last Update Date | 01/20/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972040699 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2010016286 (Missouri) | Primary |
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