# KANSAS KIDS DENTAL LLC

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

## Provider details

- **NPI number:** 1457099210
- **Authorized official:** TERESA ZWICKY (CREDENTIALING MANAGER)
- **Authorized official phone:** (480) 866-8811

## Contact information

- **Practice address:** 12708 S BLACKBOB RD STE B, OLATHE, KS 66062-1409
- **Practice address phone:** (480) 866-8811
- **Mailing address:** 5717 E THOMAS RD STE 100, SCOTTSDALE, AZ 85251-7620
- **Mailing address phone:** (480) 866-8811
- **Mailing address fax:** (602) 429-8200

## Taxonomy

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

## Other

- **Enumeration date:** 05/23/2022
- **Last updated:** 05/23/2022