NPIMap

Organization Active NPI

KC Smile, P.a.

  • Dentist
  • Overland Park, KS
National Provider Identifier
1558433946
Registry record updated Jun 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6953 Issued in KS
Legal business name
KC SMILE, P.A.
Practice address
12850 Metcalf Ave
Ste 200
Overland Park, KS 66213-2622
Phone
(913) 491-6874
Fax
(913) 491-6917
NPI assigned
Nov 14, 2006
Last updated
Jun 10, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2014

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

Authorized official

Name
Dr. Ross S Headley, DDSNPI 1982774295
Title
Owner
Phone
(913) 491-6874

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 6953 KS Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 60571 KS
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 6953 KS
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 5389 KS

Addresses

Primary practice location

12850 Metcalf Ave
Ste 200
Overland Park, KS 66213-2622

Mailing address

12850 Metcalf Ave
Ste 200
Overland Park, KS 66213-2622
Phone (913) 491-6874

National Provider Directory

National Provider Directory

Locations

12850 Metcalf Ave
Ste 200
Overland Park, KS 66213
Phone (913) 491-6874

Practitioners & affiliated clinicians

Practitioners 1

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": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402358400000",
    "number": "1558433946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12850 METCALF AVE",
            "address_2": "STE 200",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662132622",
            "telephone_number": "913-491-6874",
            "fax_number": "913-491-6917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12850 METCALF AVE",
            "address_2": "STE 200",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662132622",
            "telephone_number": "913-491-6874",
            "fax_number": "913-491-6917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KC SMILE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2014-06-10",
        "status": "A",
        "authorized_official_last_name": "HEADLEY",
        "authorized_official_first_name": "ROSS",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "913-491-6874",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "KS",
            "license": "6953",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "KS",
            "license": "60571",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "KS",
            "license": "6953",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "KS",
            "license": "5389",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2014; 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.