Provider Demographics
NPI:1417727967
Name:SWEET TOOTH GRANDVIEW LLC
Entity Type:Organization
Organization Name:SWEET TOOTH GRANDVIEW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-276-3809
Mailing Address - Street 1:6600 COLLEGE BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1522
Mailing Address - Country:US
Mailing Address - Phone:913-276-3809
Mailing Address - Fax:
Practice Address - Street 1:11908 BLUE RIDGE EXT
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-1160
Practice Address - Country:US
Practice Address - Phone:913-276-3809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental