NPIMap

Organization Active NPI

Claycomo Dental LLC

  • Dental Clinic/Center
  • Kansas City, MO
National Provider Identifier
1942746896
Registry record updated Jan 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
2009016386 Issued in MO
Legal business name
CLAYCOMO DENTAL LLC
Practice address
244 E US Highway 69
Suite 101
Kansas City, MO 64119-3184
Phone
(816) 454-1313
NPI assigned
Jan 17, 2017
Last updated
Jan 17, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2017

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

Authorized official

Name
Bryan ShewanickNPI 1083841662
Title
Member
Phone
(816) 454-1313

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 2014022711 MO
Dental Clinic/Center 261QD0000X 2014018762 MO
Dental Clinic/Center 261QD0000X 2009016386 MO Primary

Addresses

Primary practice location

244 E US Highway 69
Suite 101
Kansas City, MO 64119-3184

Mailing address

244 E US Highway 69
Suite 101
Kansas City, MO 64119-3184

National Provider Directory

National Provider Directory

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": "1484611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484611200000",
    "number": "1942746896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 E US HIGHWAY 69",
            "address_2": "SUITE 101",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641193184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 E US HIGHWAY 69",
            "address_2": "SUITE 101",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641193184",
            "telephone_number": "816-454-1313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAYCOMO DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-17",
        "last_updated": "2017-01-17",
        "status": "A",
        "authorized_official_last_name": "SHEWANICK",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "816-454-1313"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MO",
            "license": "2014022711",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MO",
            "license": "2014018762",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MO",
            "license": "2009016386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2017; 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.