Provider Demographics
NPI:1477090090
Name:RM DENTAL GROUP PLAZA
Entity Type:Organization
Organization Name:RM DENTAL GROUP PLAZA
Other - Org Name:ROME AND MCCLELLAN DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:ROME
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-714-4990
Mailing Address - Street 1:4532 BROADWAY
Mailing Address - Street 2:APT 3S
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111
Mailing Address - Country:US
Mailing Address - Phone:816-714-4990
Mailing Address - Fax:
Practice Address - Street 1:315 NICHOLS RD
Practice Address - Street 2:STE 211
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111
Practice Address - Country:US
Practice Address - Phone:816-714-4990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016042390122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty