# CLAYCOMO DENTAL LLC

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

## Provider details

- **NPI number:** 1942746896
- **Authorized official:** BRYAN SHEWANICK (MEMBER)
- **Authorized official phone:** (816) 454-1313

## Contact information

- **Practice address:** 244 E US HIGHWAY 69, SUITE 101, KANSAS CITY, MO 64119-3184
- **Practice address phone:** (816) 454-1313
- **Mailing address:** 244 E US HIGHWAY 69, SUITE 101, KANSAS CITY, MO 64119-3184

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 2009016386 | MO | Yes |
| 261QD0000X | Dental Clinic/Center | 2014018762 | MO | — |
| 261QD0000X | Dental Clinic/Center | 2014022711 | MO | — |

## Other

- **Enumeration date:** 01/17/2017
- **Last updated:** 01/17/2017