Individual
KIRTHI TATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
114 E 41ST ST, APT 3, KANSAS CITY, MO 64111-4927
(334) 329-4844
Mailing address
355 OZARK TRAIL DR STE 8, ELLISVILLE, MO 63011-2164
(334) 329-4844
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2018015358
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/17/2017
Last updated
07/29/2019
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