Provider Demographics
NPI:1477289064
Name:SWEET TOOTH OLATHE, LLC
Entity Type:Organization
Organization Name:SWEET TOOTH OLATHE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-343-5072
Mailing Address - Street 1:15933 W 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-9342
Mailing Address - Country:US
Mailing Address - Phone:208-220-3785
Mailing Address - Fax:
Practice Address - Street 1:13095 S MUR LEN RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1425
Practice Address - Country:US
Practice Address - Phone:913-764-6222
Practice Address - Fax:913-764-5826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental