Provider Demographics
NPI:1851482756
Name:KIENE DENTAL GROUP LLC
Entity Type:Organization
Organization Name:KIENE DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:VIELHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-631-5622
Mailing Address - Street 1:11005 W 60TH ST
Mailing Address - Street 2:STE. 240
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66203-2913
Mailing Address - Country:US
Mailing Address - Phone:913-631-5622
Mailing Address - Fax:913-631-9299
Practice Address - Street 1:11005 W 60TH ST
Practice Address - Street 2:STE. 240
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66203-2913
Practice Address - Country:US
Practice Address - Phone:913-631-5622
Practice Address - Fax:913-631-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS62851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty