Provider Demographics
NPI:1639684079
Name:MIDTOWN PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:MIDTOWN PEDIATRIC DENTISTRY
Other - Org Name:THE SMILE SPOT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-601-4413
Mailing Address - Street 1:10800 FARLEY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1444
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3315 GILLHAM PLZ
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64109-1745
Practice Address - Country:US
Practice Address - Phone:816-756-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty