# ILLUMINATE FAMILY DENTISTRY, 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:** 1316691736
- **Authorized official:** DR. RACHEL HAYES CLARK DDS (OWNER DENTIST)
- **Authorized official phone:** (316) 847-7730

## Contact information

- **Practice address:** 250 W RED POWELL DR STE 500, DERBY, KS 67037-2626
- **Practice address phone:** (316) 847-7730
- **Mailing address:** 2113 N WOODARD ST, DERBY, KS 67037-2364

## Taxonomy

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

## Other

- **Enumeration date:** 02/04/2022
- **Last updated:** 02/04/2022