Provider Demographics
NPI:1558950956
Name:FOXRIDGE DENTAL
Entity Type:Organization
Organization Name:FOXRIDGE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEDEREE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:316-519-5862
Mailing Address - Street 1:5715 W 81ST ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-4804
Mailing Address - Country:US
Mailing Address - Phone:316-519-5862
Mailing Address - Fax:
Practice Address - Street 1:5517 FOXRIDGE DR
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-1556
Practice Address - Country:US
Practice Address - Phone:316-519-5862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty