| Special Care Dental Of Kansas, Llc | |
|
11111 Nall Ave Suite 100 Leawood KS 66211-1924 | |
| (502) 244-2441 | |
| (502) 254-4086 |
| Full Name | Special Care Dental Of Kansas, Llc |
|---|---|
| Speciality | Dentist |
| Location | 11111 Nall Ave, Leawood, Kansas |
| Authorized Official Name and Position | Leah Francis (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 5022442441 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Special Care Dental Of Kansas, Llc 12910 Shelbyville Rd Ste 300 Louisville KY 40243-2404 Ph: (502) 244-2441 | Special Care Dental Of Kansas, Llc 11111 Nall Ave Suite 100 Leawood KS 66211-1924 Ph: (502) 244-2441 |
| NPI Number | 1356783146 |
|---|---|
| Provider Enumeration Date | 07/23/2013 |
| Last Update Date | 08/18/2014 |
| Medicare PECOS PAC ID | 3274815212 |
|---|---|
| Medicare Enrollment ID | O20170126001425 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356783146 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| Provider Name | Phillip M Brockington |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1063575967 PECOS PAC ID: 1850673542 Enrollment ID: I20170228000935 |
| Provider Name | Kristy K Fisher |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1477573442 PECOS PAC ID: 3072803915 Enrollment ID: I20170411002400 |
| Provider Name | Hal Hale |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1114905270 PECOS PAC ID: 2769759851 Enrollment ID: I20170519002029 |
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