NPIMap

Organization Active NPI

Independence Dental, LLC

  • Dental Clinic/Center
  • Independence, KS
National Provider Identifier
1104598721
Registry record updated Oct 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
INDEPENDENCE DENTAL, LLC
Practice address
308 N 6TH St
Independence, KS 67301-3129
Phone
(620) 331-4499
NPI assigned
Oct 1, 2021
Last updated
Oct 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Juan Camilo Reynolds, DDSNPI 1891468641
Title
Owner/Dentist
Phone
(918) 907-1335

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

308 N 6TH St
Independence, KS 67301-3129

Mailing address

308 N 6TH St
Independence, KS 67301-3129
Phone (620) 331-4499

National Provider Directory

National Provider Directory

Locations

308 N 6th St
Independence, KS 67301
Phone (620) 331-4499

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633046400000",
    "number": "1104598721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 N 6TH ST",
            "city": "INDEPENDENCE",
            "state": "KS",
            "postal_code": "673013129",
            "telephone_number": "620-331-4499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 N 6TH ST",
            "city": "INDEPENDENCE",
            "state": "KS",
            "postal_code": "673013129",
            "telephone_number": "620-331-4499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-01",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "CAMILO",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "918-907-1335",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Independence, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.