NPIMap

Organization Active NPI

Excelsior Springs Family Dentistry LLC

  • General Practice Dentistry
  • Excelsior Springs, MO
National Provider Identifier
1508330986
Registry record updated Dec 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
EXCELSIOR SPRINGS FAMILY DENTISTRY LLC
Practice address
196 S. McCleary Rd
Excelsior Springs, MO 64024
Phone
(816) 630-5713
Fax
(816) 630-0392
NPI assigned
Jan 18, 2019
Last updated
Dec 2, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2020

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

Authorized official

Name
Kari J Simmons
Title
Office Manager
Phone
(816) 630-5713

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

196 S. McCleary Rd
Excelsior Springs, MO 64024

Mailing address

196 S. McCleary Rd
Excelsior Springs, MO 64024
Phone (816) 630-5713

Other identifiers 2

IdentifierTypeStateIssuer
1063426799OtherMODDS
1306850680OtherMODDS

National Provider Directory

National Provider Directory

Locations

196 S McCleary Rd
Excelsior Springs, MO 64024
Phone (816) 630-5713

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1547769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606867200000",
    "number": "1508330986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 S. MCCLEARY RD",
            "city": "EXCELSIOR SPRINGS",
            "state": "MO",
            "postal_code": "64024",
            "telephone_number": "816-630-5713",
            "fax_number": "816-630-0392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "196 S. MCCLEARY RD",
            "city": "EXCELSIOR SPRINGS",
            "state": "MO",
            "postal_code": "64024",
            "telephone_number": "816-630-5713",
            "fax_number": "816-630-0392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELSIOR SPRINGS FAMILY DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-18",
        "last_updated": "2020-12-02",
        "certification_date": "2020-12-02",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "KARI",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "816-630-5713"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DDS",
            "identifier": "1063426799",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DDS",
            "identifier": "1306850680",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Excelsior Springs, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 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.