Provider Demographics
NPI:1760941124
Name:ARCH DENTAL, P.A.
Entity Type:Organization
Organization Name:ARCH DENTAL, P.A.
Other - Org Name:PLATINUM FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-260-6080
Mailing Address - Street 1:209 NE BARRY RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2721
Mailing Address - Country:US
Mailing Address - Phone:816-454-6443
Mailing Address - Fax:
Practice Address - Street 1:209 NE BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2721
Practice Address - Country:US
Practice Address - Phone:816-454-6443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARCH DENTAL, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-15
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty