Provider Demographics
NPI:1215198247
Name:JACOB A LAUDIE DDS LLC
Entity Type:Organization
Organization Name:JACOB A LAUDIE DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAUDIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-524-3535
Mailing Address - Street 1:622 SW 3RD ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2280
Mailing Address - Country:US
Mailing Address - Phone:816-524-3535
Mailing Address - Fax:816-524-3530
Practice Address - Street 1:622 SW 3RD ST
Practice Address - Street 2:SUITE M
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2280
Practice Address - Country:US
Practice Address - Phone:816-524-3535
Practice Address - Fax:816-524-3530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006014154122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty