Provider Demographics
NPI:1215362066
Name:MY DENTIST WESTERN, KC, PA
Entity Type:Organization
Organization Name:MY DENTIST WESTERN, KC, PA
Other - Org Name:MY DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF DENTAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-753-1237
Mailing Address - Street 1:PO BOX 702620
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-2620
Mailing Address - Country:US
Mailing Address - Phone:405-286-9024
Mailing Address - Fax:405-286-9088
Practice Address - Street 1:7848 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-2417
Practice Address - Country:US
Practice Address - Phone:913-299-1001
Practice Address - Fax:913-299-1002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MY DENTIST HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty