Organization
EASTRIDGE FAMILY DENTAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD NELSON (OWNER)
(405) 260-6080
Entity
Organization
Contact information
Practice address
325 SE WILSON ST, LEES SUMMIT, MO 64063-2715
(816) 525-0399
Mailing address
325 SE WILSON ST, LEES SUMMIT, MO 64063-2715
(816) 525-0399
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/17/2020
Last updated
02/05/2024
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