# SPECIAL CARE DENTAL OF MISSOURI LLC

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

## Provider details

- **NPI number:** 1790127512
- **Authorized official:** LESLIE SEPANEK (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (502) 813-4415

## Contact information

- **Practice address:** 11111 NALL AVE, SUITE 100, LEAWOOD, KS 66211-1924
- **Practice address phone:** (502) 244-2441
- **Practice address fax:** (502) 254-4086
- **Mailing address:** 12910 SHELBYVILLE RD STE 300, LOUISVILLE, KY 40243-2404
- **Mailing address phone:** (502) 244-2441
- **Mailing address fax:** (502) 254-4086

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |
| 124Q00000X | Dental Hygienist | — | NULL | — |
| 124Q00000X | Dental Hygienist | — | — | — |

## Other

- **Enumeration date:** 07/22/2013
- **Last updated:** 12/09/2016