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Organization
BUCCAL UP DENTAL OLATHE LLC
Active
Organization
BUCCAL UP DENTAL OLATHE LLC
Active
Other names
Your Olathe Dentist
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA CONDLEY (CREDENTIALING SPECIALIST)
(918) 960-3070
Entity
Organization
Contact information
Practice address
11132 S LONE ELM RD, OLATHE, KS 66061-9434
(913) 780-0123
(913) 829-9510
Mailing address
5314 S YALE AVE STE 400, TULSA, OK 74135-6271
(918) 960-3070
(539) 867-1236
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376521765
NPI
KS
Enumeration date
06/28/2022
Last updated
06/28/2022
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