Provider Demographics
NPI:1629580063
Name:I SMILE KCK LLC
Entity Type:Organization
Organization Name:I SMILE KCK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEANN
Authorized Official - Middle Name:RICHARDS
Authorized Official - Last Name:BEHRENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-299-6699
Mailing Address - Street 1:6420 PARALLEL PKWY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-1043
Mailing Address - Country:US
Mailing Address - Phone:913-299-6699
Mailing Address - Fax:913-299-2256
Practice Address - Street 1:6420 PARALLEL PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1043
Practice Address - Country:US
Practice Address - Phone:913-299-6699
Practice Address - Fax:913-299-2256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6422261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental