Provider Demographics
NPI:1093934747
Name:JOHN K. KIESENDAHL, D.D.S.,P.C.
Entity Type:Organization
Organization Name:JOHN K. KIESENDAHL, D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KIESENDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-942-7789
Mailing Address - Street 1:400 E RED BRIDGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4035
Mailing Address - Country:US
Mailing Address - Phone:816-942-7789
Mailing Address - Fax:816-942-5964
Practice Address - Street 1:400 E RED BRIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-4035
Practice Address - Country:US
Practice Address - Phone:816-942-7789
Practice Address - Fax:816-942-5964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO10852122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty