Blacker Family Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

BLACKER FAMILY DENTAL LLC

Practice address

11208 Quincy Ave
Kansas City, MO 64137-2504

Phone

(816) 763-8400

Fax

(816) 765-8403

NPI assigned

Aug 28, 2023

Organization subpart

No

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

Authorized official

Name

Sonja Wells

Title

Office Manager

Phone

(816) 763-8400

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kyle Z Blacker, DDS

  • General Practice Dentistry
  • Kansas City, MO
  • NPI 1104353788
  NPD
• Mitchell Blacker

  • General Practice Dentistry
  • Kansas City, MO
  • NPI 1497718969
  NPD (past)

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

{
    "created_epoch": "1693180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1518742675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11208 QUINCY AVE",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641372504",
            "telephone_number": "816-763-8400",
            "fax_number": "816-765-8403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11208 QUINCY AVE",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641372504",
            "telephone_number": "816-763-8400",
            "fax_number": "816-765-8403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKER FAMILY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-28",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "SONJA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "816-763-8400"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Molly Dianne Black, MD
• Philip Greyson Black, M.D.
• Renee Black, LMSW
• Thomas C Black, MD
• Molly M Blackburn, FNP-C
• Kyle Z Blacker, DDS
• Mitchell Blacker
• Scott Blackmer, PMHNP-BC
• Crissy Blacksher, PHARMD
• Angela Labrie Blackwell, PHD, OTR/L

• General Practice Dentistry in Kansas City, MO
• Providers in Kansas City, 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 Aug 28, 2023; 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.