Organization
THE INDIAN SPRINGS DENTAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENELL STUMP (DIRECTOR, LICENSING & CREDENTIALING)
(913) 287-7977
Entity
Organization
Contact information
Practice address
4655 STATE AVE, KANSAS CITY, KS 66102-3603
(913) 287-7977
(913) 287-5022
Mailing address
4655 STATE AVE, KANSAS CITY, KS 66102-3601
(913) 287-7977
(913) 287-5022
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144207705
—
MO
05
—
200383490A
—
KS
Enumeration date
12/26/2005
Last updated
03/26/2015
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