Organization
SPECIAL CARE DENTAL OF MISSOURI LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE SEPANEK (CREDENTIALING SPECIALIST)
(502) 813-4415
Entity
Organization
Contact information
Practice address
11111 NALL AVE, SUITE 100, LEAWOOD, KS 66211-1924
(502) 244-2441
(502) 254-4086
Mailing address
12910 SHELBYVILLE RD STE 300, LOUISVILLE, KY 40243-2404
(502) 244-2441
(502) 254-4086
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
124Q00000X
Dental Hygienist
—
—
Other
Enumeration date
07/22/2013
Last updated
12/09/2016
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