1992786412 NPI number — UMKC SCHOOL OF DENTISTRY

Table of content: (NPI 1992786412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992786412 NPI number — UMKC SCHOOL OF DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UMKC SCHOOL OF DENTISTRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992786412
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 E 25TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64108-2716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-235-2136
Provider Business Mailing Address Fax Number:
816-235-5472

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 E 25TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64108-2716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-235-2136
Provider Business Practice Location Address Fax Number:
816-235-5472
Provider Enumeration Date:
11/10/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WELLS
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
ASSOCIATE DEAN, CLINICAL PROGRAMS
Authorized Official Telephone Number:
816-235-2152

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  11597 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD0000X , with the licence number: 2011013371 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 400519401 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".