Cassandra Collins McKenzie, MA, DDS, MS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

61312 Issued in KS

Practice address

13316 Metcalf Ave
Overland Park, KS 66213-2804

Phone

(913) 851-5110

NPI assigned

Jul 9, 2014

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Overland Park Modern Dentistry PA

  dba Overland Park Modern Dentistry

  • General Practice Dentistry
  • Overland Park, KS
  • NPI 1215367172
  NPD (past)

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

{
    "created_epoch": "1404864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1922414168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13316 METCALF AVE",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662132804",
            "telephone_number": "913-851-5110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13316 METCALF AVE",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662132804",
            "telephone_number": "913-851-5110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENZIE",
        "first_name": "CASSANDRA",
        "middle_name": "COLLINS",
        "name_prefix": "Dr.",
        "credential": "MA, DDS, MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-09",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MO",
            "license": "2014021685",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "KS",
            "license": "61312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERIODONTICS - KANSAS DENTAL BOARD",
            "identifier": "61312",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL SPECIALIST - MISSOURI DENTAL BOARD",
            "identifier": "2014021685",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James P McHugh, PH.D.
• Stephanie Lynn McIlwraith
• Christina Rena McKee, M A CCC SLP
• Jamie McKee
• Micaela Leigh McKenna, MSW, LCSW
• Kenny Githere McKenzie, DPT
• Rebecca P McKeon, CRNA
• Christopher P McKinney, M.D.
• Jennifer Anne McKinsey, M.D.
• Tara McKinzy

• Periodontics in Overland Park, KS
• Providers in Overland Park, KS by specialty
• Periodontics in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.