| Special Care Dental Of Missouri Llc | |
|
11111 Nall Ave Suite 100 Leawood KS 66211-1924 | |
| (502) 244-2441 | |
| (502) 254-4086 |
| Full Name | Special Care Dental Of Missouri Llc |
|---|---|
| Speciality | Dentist |
| Location | 11111 Nall Ave, Leawood, Kansas |
| Authorized Official Name and Position | Leslie Sepanek (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 5028134415 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Special Care Dental Of Missouri Llc 12910 Shelbyville Rd Ste 300 Louisville KY 40243-2404 Ph: (502) 244-2441 | Special Care Dental Of Missouri Llc 11111 Nall Ave Suite 100 Leawood KS 66211-1924 Ph: (502) 244-2441 |
| NPI Number | 1790127512 |
|---|---|
| Provider Enumeration Date | 07/22/2013 |
| Last Update Date | 12/09/2016 |
| Medicare PECOS PAC ID | 4082995667 |
|---|---|
| Medicare Enrollment ID | O20161220001976 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790127512 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 124Q00000X | Dental Hygienist | (* (Not Available)) | Secondary |
| Provider Name | Ashley V Welker |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1386083640 PECOS PAC ID: 8224342282 Enrollment ID: I20170105001362 |
| Provider Name | Phillip M Brockington |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1063575967 PECOS PAC ID: 1850673542 Enrollment ID: I20170112001021 |
| Provider Name | Kristy K Fisher |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1477573442 PECOS PAC ID: 3072803915 Enrollment ID: I20170112001178 |
| Provider Name | Darrell W Davis |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1750430955 PECOS PAC ID: 4183906878 Enrollment ID: I20170112001224 |
| Provider Name | Rivka Goldenhersh |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1932405792 PECOS PAC ID: 3072895713 Enrollment ID: I20170112003344 |
| Provider Name | Anthony K Lee |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1831207711 PECOS PAC ID: 9234437575 Enrollment ID: I20170125002435 |
| Provider Name | Diane Hall |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1639239783 PECOS PAC ID: 3173806734 Enrollment ID: I20170207000572 |
| Provider Name | Mark Bagby |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1477755775 PECOS PAC ID: 9739466145 Enrollment ID: I20170614000901 |
Asha Smiles Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 11100 Ash St, Suite 204, Leawood, KS 66211 Phone: 913-491-6282 Fax: 913-491-1844 | |
Peppes Dental Group P.a. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 11551 Granada Ln, Suite 200, Leawood, KS 66211 Phone: 913-642-3939 Fax: 913-642-3508 | |
Midwest Oral & Maxillofacial Surgery, Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 11551 Granada Lane, 100, Leawood, KS 66211 Phone: 913-491-4488 Fax: 913-491-5073 | |
University Park Endodontics Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 11201 Nall Ave, Ste 130, Leawood, KS 66211 Phone: 913-491-0056 Fax: 913-491-5220 | |
Mona Barber, D.d.s., P.a. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 11111 Nall Ave Ste 208, Leawood, KS 66211 Phone: 913-491-4411 | |
Luke Joliff, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 11551 Granada St Ste 200, Leawood, KS 66211 Phone: 913-642-3939 | |
Smiley Dental, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 13430 Briar Dr, Leawood, KS 66209 Phone: 913-402-8888 Fax: 913-402-8808 |