| The Indian Springs Dental Clinic, Llc | |
|
4655 State Ave Kansas City KS 66102-3603 | |
| (913) 287-7977 | |
| (913) 287-5022 |
| Full Name | The Indian Springs Dental Clinic, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4655 State Ave, Kansas City, Kansas |
| Authorized Official Name and Position | Jenell Stump (DIRECTOR, LICENSING & CREDENTIALING) |
| Authorized Official Contact | 9132877977 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Indian Springs Dental Clinic, Llc 4655 State Ave Kansas City KS 66102-3601 Ph: (913) 287-7977 | The Indian Springs Dental Clinic, Llc 4655 State Ave Kansas City KS 66102-3603 Ph: (913) 287-7977 |
| NPI Number | 1144207705 |
|---|---|
| Provider Enumeration Date | 12/26/2005 |
| Last Update Date | 03/26/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144207705 | NPI | - | NPPES |
| 1144207705 | Medicaid | MO | |
| 200383490A | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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