Organization
SUMMIT PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONCY MATHEW DDS (OWNER/DENTIST)
(816) 256-0073
Entity
Organization
Contact information
Practice address
24 NW CHIPMAN RD STE B, LEES SUMMIT, MO 64063-1929
(816) 256-0073
Mailing address
24 NW CHIPMAN RD STE B, LEES SUMMIT, MO 64063-1929
(816) 256-0073
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2006037222
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841474293
—
MO
Enumeration date
05/17/2017
Last updated
07/21/2022
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