Provider Demographics
NPI:1023277431
Name:MORENO FAMILY DENTISTRY
Entity type:Organization
Organization Name:MORENO FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-647-1900
Mailing Address - Street 1:753 STATE AVE
Mailing Address - Street 2:STE 375
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66101-2516
Mailing Address - Country:US
Mailing Address - Phone:913-647-1900
Mailing Address - Fax:913-647-1901
Practice Address - Street 1:753 STATE AVE
Practice Address - Street 2:STE 375
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66101-2516
Practice Address - Country:US
Practice Address - Phone:913-647-1900
Practice Address - Fax:913-647-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty