Provider Demographics
NPI:1902226855
Name:EMILY KATHERINE HANDLEY, DDS, PC
Entity Type:Organization
Organization Name:EMILY KATHERINE HANDLEY, DDS, PC
Other - Org Name:RAYTOWN DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8426
Mailing Address - Street 1:10803 E 350 HWY
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64138-2313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10803 E 350 HWY
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138-2313
Practice Address - Country:US
Practice Address - Phone:816-356-4008
Practice Address - Fax:816-358-4008
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMILY KATHERINE HANDLEY, DDS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-18
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty