Organization
CLAYCOMO DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN SHEWANICK (MEMBER)
(816) 454-1313
Entity
Organization
Contact information
Practice address
244 E US HIGHWAY 69, SUITE 101, KANSAS CITY, MO 64119-3184
(816) 454-1313
Mailing address
244 E US HIGHWAY 69, SUITE 101, KANSAS CITY, MO 64119-3184
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
2009016386
MO
261QD0000X
Dental Clinic/Center
2014018762
MO
261QD0000X
Dental Clinic/Center
2014022711
MO
Other
Enumeration date
01/17/2017
Last updated
01/17/2017
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