Jacob Matthew Anderson, D.D.S.
Individual provider Active NPI Dentist · Lees Summit, MO
NPI 1487063152 · NPPES record last updated Jan 2, 2021
Key facts
- NPI
- 1487063152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2014016763 (MO)
- Practice address
- 300 SE 2ND St Ste 200
Lees Summit, MO 64063-2759 - Phone
- (816) 524-6300
- NPI assigned
- Aug 7, 2014
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2014016763 | MO | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Careswell & Anderson Dental LLC | Current |
Accepting new patients | |
| Kallsnick & Careswell | Past |
Accepting new patients |
Locations
300 SE 2nd St
Ste 200
Lees Summit, MO 64063
Phone (816) 524-6300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2014016763 | MO | Yes |
Addresses
Primary practice location
300 SE 2ND St Ste 200
Lees Summit, MO 64063-2759
Mailing address
300 SE 2ND St Ste 200
Lees Summit, MO 64063-2759
Phone (816) 524-6300
Other practice location 1
652 Hamilton Rd
USA Dental Activity
Ft. Sill, OK 73503
Phone (580) 442-3905
Other providers in Lees Summit, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 2, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.