NPIMap

Organization Active NPI

Kansas Kids Dental LLC

  • General Practice Dentistry
  • Olathe, KS
National Provider Identifier
1457099210
Registry record updated May 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
KANSAS KIDS DENTAL LLC
Practice address
12708 S Blackbob Rd Ste B
Olathe, KS 66062-1409
Phone
(480) 866-8811
NPI assigned
May 23, 2022
Last updated
May 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2022

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

Authorized official

Name
Teresa Zwicky
Title
Credentialing Manager
Phone
(480) 866-8811

Specialties & licenses 1

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

Addresses

Primary practice location

12708 S Blackbob Rd Ste B
Olathe, KS 66062-1409

Mailing address

5717 E Thomas Rd Ste 100
Scottsdale, AZ 85251-7620
Phone (480) 866-8811

National Provider Directory

National Provider Directory

Locations

12708 S Blackbob Rd
Ste B
Olathe, KS 66062
Phone (913) 225-9749

NPI Registry JSON

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

{
    "created_epoch": "1653264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653264000000",
    "number": "1457099210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5717 E THOMAS RD STE 100",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852517620",
            "telephone_number": "480-866-8811",
            "fax_number": "602-429-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12708 S BLACKBOB RD STE B",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "660621409",
            "telephone_number": "480-866-8811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KANSAS KIDS DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-23",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A",
        "authorized_official_last_name": "ZWICKY",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "480-866-8811"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olathe, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2022; 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.