Provider Demographics
NPI:1407165202
Name:THE VILLAGE DENTIST
Entity Type:Organization
Organization Name:THE VILLAGE DENTIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCAROY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-789-7455
Mailing Address - Street 1:6925 TOMAHAWK RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-2618
Mailing Address - Country:US
Mailing Address - Phone:913-789-7455
Mailing Address - Fax:913-789-9809
Practice Address - Street 1:6925 TOMAHAWK RD
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-2618
Practice Address - Country:US
Practice Address - Phone:913-789-7455
Practice Address - Fax:913-789-9809
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE FAMILY DENTAL PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS602591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty