NPIMap

Organization Active NPI

South Independence Dental LLC

  • Dentist
  • Independence, MO
National Provider Identifier
1245842202
Registry record updated Sep 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
SOUTH INDEPENDENCE DENTAL LLC
Practice address
12400 E 40 Hwy
Independence, MO 64055-5929
Phone
(816) 897-5850
Fax
(816) 897-5851
NPI assigned
Aug 20, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2020

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

Authorized official

Name
Dr. Michael Lee, DDSNPI 1174902654
Title
Partner
Phone
(816) 897-5850

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

12400 E 40 Hwy
Independence, MO 64055-5929

Mailing address

12400 E 40 Hwy
Independence, MO 64055-5929
Phone (816) 897-5850

National Provider Directory

National Provider Directory

Locations

12400 E US Highway 40
Independence, MO 64055
Phone (816) 890-9507

Practitioners & affiliated clinicians

Practitioners 3

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": "1597881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600041600000",
    "number": "1245842202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12400 E 40 HWY",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640555929",
            "telephone_number": "816-897-5850",
            "fax_number": "816-897-5851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12400 E 40 HWY",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640555929",
            "telephone_number": "816-897-5850",
            "fax_number": "816-897-5851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH INDEPENDENCE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-20",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-01",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "816-897-5850",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Independence, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2020; 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.