KC Dental Professionals, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

KC DENTAL PROFESSIONALS, PA

Doing business as

Deer Creek Family Dental Care

Practice address

13328 Metcalf Ave
Overland Park, KS 66213-2804

Phone

(913) 345-2273

Fax

(913) 345-8102

NPI assigned

May 22, 2009

Organization subpart

Yes

Parent organization

KC DENTAL PROFESSIONALS, PAAs reported in NPPES

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

Authorized official

Name

Kim Wilson

Title

Insurance/Credentialing

Phone

(217) 540-5100

Specialties & licenses 1

Addresses

Other names 1

• Deer Creek Family Dental Care Doing business as

Locations

Practitioners 2

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.

• Adrian D Mohn, DDS

  • General Practice Dentistry
  • Overland Park, KS
  • NPI 1356470991
  NPD (past)
• Jahn Roedemeier, D.D.S.

  • General Practice Dentistry
  • Overland Park, KS
  • NPI 1063594083
  NPD (past)

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

{
    "created_epoch": "1242950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352764800000",
    "number": "1851526693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13328 METCALF AVE",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662132804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13328 METCALF AVE",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662132804",
            "telephone_number": "913-345-2273",
            "fax_number": "913-345-8102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KC DENTAL PROFESSIONALS, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KC DENTAL PROFESSIONALS, PA",
        "enumeration_date": "2009-05-22",
        "last_updated": "2012-11-13",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "INSURANCE/CREDENTIALING",
        "authorized_official_telephone_number": "217-540-5100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deer Creek Family Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• KC Character Development
• KC Concierge Services, LLC (KC Concierge Services)
• KC Connect Physical Therapy LLC (KC Connect PT)
• KC Core Ca LLC (KC Core)
• KC Counseling Center
• KC Developmental Therapies, LLC
• KC Diabetes & Endocrinology PA
• KC Hospitalists, P.a.
• KC Mind & Wellness Center LLC
• KC Pathology PA

• General Practice Dentistry in Overland Park, KS
• Providers in Overland Park, KS by specialty
• General Practice Dentistry in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2012; 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.