Provider Demographics
NPI:1760093892
Name:WESTPORT FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:WESTPORT FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:SMITKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-531-0382
Mailing Address - Street 1:104 ARCHIBALD ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2230
Mailing Address - Country:US
Mailing Address - Phone:816-531-0382
Mailing Address - Fax:
Practice Address - Street 1:104 ARCHIBALD ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2230
Practice Address - Country:US
Practice Address - Phone:816-531-0382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental