Provider Demographics
NPI:1578850319
Name:ADVANCED DENTAL ARTS, LLC
Entity Type:Organization
Organization Name:ADVANCED DENTAL ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-332-2412
Mailing Address - Street 1:4444 N BELLEVIEW AVE
Mailing Address - Street 2:SUITE #202
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-1507
Mailing Address - Country:US
Mailing Address - Phone:816-452-1888
Mailing Address - Fax:816-455-2578
Practice Address - Street 1:4444 N BELLEVIEW AVE
Practice Address - Street 2:SUITE #202
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-1507
Practice Address - Country:US
Practice Address - Phone:816-452-1888
Practice Address - Fax:816-455-2578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070172801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty