Organization
BUCCAL UP DENTAL OLATHE LLC
Active
Other names
Your Olathe Dentist
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA CONDLEY (CREDENTIALING SPECIALIST)
(918) 960-3070
Entity
Organization
Contact information
Practice address
11132 S LONE ELM RD, OLATHE, KS 66061-9434
(913) 780-0123
(913) 829-9510
Mailing address
5314 S YALE AVE STE 400, TULSA, OK 74135-6271
(918) 960-3070
(539) 867-1236
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376521765
NPI
KS
Enumeration date
06/28/2022
Last updated
06/28/2022
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