Provider Demographics
NPI:1558433946
Name:KC SMILE, P.A.
Entity Type:Organization
Organization Name:KC SMILE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:S
Authorized Official - Last Name:HEADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-491-6874
Mailing Address - Street 1:12850 METCALF AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2622
Mailing Address - Country:US
Mailing Address - Phone:913-491-6874
Mailing Address - Fax:913-491-6917
Practice Address - Street 1:12850 METCALF AVE
Practice Address - Street 2:STE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2622
Practice Address - Country:US
Practice Address - Phone:913-491-6874
Practice Address - Fax:913-491-6917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6953122300000X, 1223G0001X
KS60571122300000X
KS53891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty