| Lighthouse Dental LLC | |
|
10803a E 350 Hwy Raytown MO 64138 | |
| (816) 356-2476 | |
| (816) 353-1430 |
| Full Name | Lighthouse Dental LLC |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 10803a E 350 Hwy, Raytown, Missouri |
| Authorized Official Name and Position | Jack E Ferguson (CO OWNER DENTIST) |
| Authorized Official Contact | 8163562476 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Dental LLC 10803a E 350 Hwy Raytown MO 64138 Ph: (816) 356-2476 | Lighthouse Dental LLC 10803a E 350 Hwy Raytown MO 64138 Ph: (816) 356-2476 |
| NPI Number | 1710045224 |
|---|---|
| Provider Enumeration Date | 12/05/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710045224 | NPI | - | NPPES |
| 09718037 | Other | MO | BCBS |
| 33345021 | Other | MO | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | () | Primary |
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