Provider Demographics
NPI:1922401397
Name:BARON DENTAL LLC
Entity Type:Organization
Organization Name:BARON DENTAL LLC
Other - Org Name:KING DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-716-1000
Mailing Address - Street 1:1170 W KANSAS ST
Mailing Address - Street 2:SUITE R-2
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-2036
Mailing Address - Country:US
Mailing Address - Phone:816-716-1000
Mailing Address - Fax:
Practice Address - Street 1:1170 W KANSAS ST
Practice Address - Street 2:SUITE R-2
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-2036
Practice Address - Country:US
Practice Address - Phone:816-716-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010016293122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty