NPIMap

Organization Active NPI

The Indian Springs Dental Clinic, LLC

  • General Practice Dentistry
  • Kansas City, KS
National Provider Identifier
1144207705
Registry record updated Mar 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
THE INDIAN SPRINGS DENTAL CLINIC, LLC
Practice address
4655 State Ave
Kansas City, KS 66102-3603
Phone
(913) 287-7977
Fax
(913) 287-5022
NPI assigned
Dec 26, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2015

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

Authorized official

Name
Mrs. Jenell Stump
Title
Director, Licensing & Credentialing
Phone
(913) 287-7977

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

4655 State Ave
Kansas City, KS 66102-3603

Mailing address

4655 State Ave
Kansas City, KS 66102-3601
Phone (913) 287-7977

Other identifiers 2

IdentifierTypeStateIssuer
1144207705MedicaidMO
200383490AMedicaidKS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1135555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427328000000",
    "number": "1144207705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4655 STATE AVE",
            "city": "KANSAS CITY",
            "state": "KS",
            "postal_code": "661023601",
            "telephone_number": "913-287-7977",
            "fax_number": "913-287-5022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4655 STATE AVE",
            "city": "KANSAS CITY",
            "state": "KS",
            "postal_code": "661023603",
            "telephone_number": "913-287-7977",
            "fax_number": "913-287-5022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE INDIAN SPRINGS DENTAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-26",
        "last_updated": "2015-03-26",
        "status": "A",
        "authorized_official_last_name": "STUMP",
        "authorized_official_first_name": "JENELL",
        "authorized_official_title_or_position": "DIRECTOR, LICENSING & CREDENTIALING",
        "authorized_official_telephone_number": "913-287-7977",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1144207705",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200383490A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2015; 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.