Organization
KINGDOM KIDS DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTA SHEHAN (VICE PRESIDENT OF OPERATIONS)
(816) 674-9796
Entity
Organization
Contact information
Practice address
3102 PROSPECT AVE, KANSAS CITY, MO 64128-1559
(816) 674-9796
Mailing address
305 NW SHAGBARK ST, LEES SUMMIT, MO 64064-1447
(816) 674-9796
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/24/2024
Last updated
04/24/2024
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