Provider Demographics
NPI:1417209032
Name:PEARLY WHITES DENTAL CARE, L.L.C.
Entity Type:Organization
Organization Name:PEARLY WHITES DENTAL CARE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-721-3525
Mailing Address - Street 1:2300 HUTTON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-4424
Mailing Address - Country:US
Mailing Address - Phone:913-721-3525
Mailing Address - Fax:913-721-3627
Practice Address - Street 1:2300 HUTTON RD STE 102
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-4424
Practice Address - Country:US
Practice Address - Phone:913-721-3525
Practice Address - Fax:913-721-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60131122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty