Eastridge Family Dental, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

EASTRIDGE FAMILY DENTAL, PC

Practice address

325 SE Wilson St
Lees Summit, MO 64063-2715

Phone

(816) 525-0399

NPI assigned

Aug 17, 2020

Last updated

Feb 5, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brad Nelson

Title

Owner

Phone

(405) 260-6080

Specialties & licenses 1

Addresses

Practitioners 3

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.

• Joshua Ray Dawdy, DDS

  • Dentist
  • Lee's Summit, MO
  • NPI 1457245508
  NPD
• Dylan James Waugh, DDS

  • Dentist
  • Lee's Summit, MO
  • NPI 1669212007
  NPD
• William E. Luther Jr., D.D.S.

  • General Practice Dentistry
  • Lee's Summit, MO
  • NPI 1659479392
  NPD (past)

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

{
    "created_epoch": "1597622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707091200000",
    "number": "1427660018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 SE WILSON ST",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640632715",
            "telephone_number": "816-525-0399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 SE WILSON ST",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640632715",
            "telephone_number": "816-525-0399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTRIDGE FAMILY DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-17",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-260-6080"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ciara Dawn Dutton, OTR/L
• Dynamic Spine & Joint Center
• Robin Leslie Dyson, M.D.
• Nicholas Patrick Earley, DPT
• Eastport Chiropractic, LLC (Eastport Chiropractic)
• Michelle S Eaton, P.A.
• Marissa Lynn Ebeling, LPC
• Cari Dawne Ebert, M.S., CCC-SLP
• Alexandra Echelmeier, LCSW
• Brittany Echols

• General Practice Dentistry in Lee's Summit, MO
• Providers in Lee's Summit, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2024; 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.