Organization
VILLAGE DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY D KANNING (BUSINESS MANAGER)
(913) 908-9523
Entity
Organization
Contact information
Practice address
415 E US HIGHWAY 69, KANSAS CITY, MO 64119-3118
(816) 580-4191
Mailing address
415 E US HIGHWAY 69, KANSAS CITY, MO 64119-3118
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477164705
NPI TYPE I
MO
01
—
1477992246
NPI TYPE I
MO
Enumeration date
11/30/2020
Last updated
03/18/2024
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