# AMAZING SMILES OF KANSAS CITY, LLC

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

## Provider details

- **NPI number:** 1194072421
- **Authorized official:** KELLY MCCRACKEN D.D.S. (DENTIST/OWNER)
- **Authorized official phone:** (913) 788-7600

## Contact information

- **Practice address:** 8915 STATE AVE, KANSAS CITY, KS 66112-1645
- **Practice address phone:** (913) 788-7600
- **Practice address fax:** (913) 788-7601
- **Mailing address:** 8915 STATE AVE, KANSAS CITY, KS 66112-1645
- **Mailing address phone:** (913) 788-7600
- **Mailing address fax:** (913) 788-7601

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 60811 | KS | Yes |

## Other

- **Enumeration date:** 08/06/2012
- **Last updated:** 08/06/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1780945279 | NPI NUMBER | KS |