Provider Demographics
NPI:1750836292
Name:GREEN HILLS DENTAL KC, LLC
Entity Type:Organization
Organization Name:GREEN HILLS DENTAL KC, LLC
Other - Org Name:GREEN HILLS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-587-5555
Mailing Address - Street 1:8530 N GREEN HILLS RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-1403
Mailing Address - Country:US
Mailing Address - Phone:816-587-5555
Mailing Address - Fax:816-587-0552
Practice Address - Street 1:8530 N GREEN HILLS RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-1403
Practice Address - Country:US
Practice Address - Phone:816-587-5555
Practice Address - Fax:816-587-0552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004013324122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty