Provider Demographics
NPI:1689687741
Name:EHRENBERGER, CARYN JOY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARYN
Middle Name:JOY
Last Name:EHRENBERGER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:CARYN
Other - Middle Name:JOY
Other - Last Name:MARSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:650 E 25TH ST RM 168A
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2716
Mailing Address - Country:US
Mailing Address - Phone:816-235-2076
Mailing Address - Fax:
Practice Address - Street 1:650 E 25TH ST RM 168A
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2716
Practice Address - Country:US
Practice Address - Phone:816-235-2076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS601311223G0001X
MO20020111301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice