Organization
GLADSTONE FAMILY DENTISTRY L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEE HEISKELL (OFFICE MANAGER)
(816) 452-2420
Entity
Organization
Contact information
Practice address
6301 N OAK TRFY, SUITE 202, GLADSTONE, MO 64118-4705
(816) 452-2420
(816) 777-0836
Mailing address
6301 N OAK TRFY, SUITE 202, GLADSTONE, MO 64118-4705
(816) 452-2420
(816) 777-0836
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
011945
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09692040
BLUE CROSS
NE
Enumeration date
01/11/2008
Last updated
01/11/2008
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