Organization
KANSAS KIDS DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA ZWICKY (CREDENTIALING MANAGER)
(480) 866-8811
Entity
Organization
Contact information
Practice address
12708 S BLACKBOB RD STE B, OLATHE, KS 66062-1409
(480) 866-8811
Mailing address
5717 E THOMAS RD STE 100, SCOTTSDALE, AZ 85251-7620
(480) 866-8811
(602) 429-8200
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/23/2022
Last updated
05/23/2022
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