Provider Demographics
NPI:1194830992
Name:KALLSNICK & CARESWELL
Entity Type:Organization
Organization Name:KALLSNICK & CARESWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:KALLSNICK
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-524-6300
Mailing Address - Street 1:300 SE 2ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2759
Mailing Address - Country:US
Mailing Address - Phone:816-524-6300
Mailing Address - Fax:816-524-7648
Practice Address - Street 1:300 SE 2ND ST STE 200
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2759
Practice Address - Country:US
Practice Address - Phone:816-524-6300
Practice Address - Fax:816-524-7648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0123681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty