Provider Demographics
NPI:1811571896
Name:VILLAGE COMPLETE DENTISTRY, LLC
Entity Type:Organization
Organization Name:VILLAGE COMPLETE DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:EDGINGTON
Authorized Official - Last Name:HANNAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-381-4700
Mailing Address - Street 1:4121 W 83RD ST STE 137
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-5323
Mailing Address - Country:US
Mailing Address - Phone:913-381-4700
Mailing Address - Fax:
Practice Address - Street 1:4121 W 83RD ST STE 137
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-5323
Practice Address - Country:US
Practice Address - Phone:913-381-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental