# THE INDIAN SPRINGS DENTAL CLINIC, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144207705
- **Authorized official:** MRS. JENELL STUMP (DIRECTOR, LICENSING & CREDENTIALING)
- **Authorized official phone:** (913) 287-7977

## Contact information

- **Practice address:** 4655 STATE AVE, KANSAS CITY, KS 66102-3603
- **Practice address phone:** (913) 287-7977
- **Practice address fax:** (913) 287-5022
- **Mailing address:** 4655 STATE AVE, KANSAS CITY, KS 66102-3601
- **Mailing address phone:** (913) 287-7977
- **Mailing address fax:** (913) 287-5022

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 12/26/2005
- **Last updated:** 03/26/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1144207705 | — | MO |
| 05 | — | 200383490A | — | KS |