Organization
EXCELSIOR SPRINGS FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARI J SIMMONS (OFFICE MANAGER)
(816) 630-5713
Entity
Organization
Contact information
Practice address
196 S. MCCLEARY RD, EXCELSIOR SPRINGS, MO 64024
(816) 630-5713
(816) 630-0392
Mailing address
196 S. MCCLEARY RD, EXCELSIOR SPRINGS, MO 64024
(816) 630-5713
(816) 630-0392
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063426799
DDS
MO
01
—
1306850680
DDS
MO
Enumeration date
01/18/2019
Last updated
12/02/2020
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