Antioch Dental Inc

Primary specialty

DentistTaxonomy code 122300000X

License

60303 Issued in KS

Legal business name

ANTIOCH DENTAL INC

Practice address

8650 W 95TH St Ste 2
Overland Park, KS 66212-3246

Phone

(913) 642-0031

Fax

(913) 642-2188

NPI assigned

Jul 28, 2008

Organization subpart

No

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

Authorized official

Name

Irwin N. Boe Jr., DDS

Title

President

Phone

(913) 642-0031

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1217203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371081600000",
    "number": "1790940872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8650 W 95TH ST STE 2",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662123246",
            "telephone_number": "913-642-0031",
            "fax_number": "913-642-2188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8650 W 95TH ST STE 2",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662123246",
            "telephone_number": "913-642-0031",
            "fax_number": "913-642-2188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTIOCH DENTAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-28",
        "last_updated": "2013-06-13",
        "status": "A",
        "authorized_official_last_name": "BOE",
        "authorized_official_first_name": "IRWIN",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "913-642-0031",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "KS",
            "license": "60303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Overland Park, KS
• Dentist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2013; 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.