# GRACE DENTAL, P.A.

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

## Provider details

- **NPI number:** 1275657496
- **Authorized official:** MR. MICHAEL DANLEY RDH (GENERAL MANAGER)
- **Authorized official phone:** (913) 685-9111

## Contact information

- **Practice address:** 12611 ANTIOCH RD, OVERLAND PARK, KS 66213
- **Practice address phone:** (913) 685-9111
- **Practice address fax:** (913) 685-8486
- **Mailing address:** 12611 ANTIOCH RD, OVERLAND PARK, KS 66213
- **Mailing address phone:** (913) 685-9111
- **Mailing address fax:** (913) 685-8486

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 6166 | KS | Yes |

## Other

- **Enumeration date:** 03/16/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 13970060 | BCBS | KS |
| 01 | — | 808110 | UNITED CONCORDIA | KS |