Provider Demographics
NPI:1134422280
Name:CASS COUNTY DENTAL CLINIC, LLC
Entity type:Organization
Organization Name:CASS COUNTY DENTAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-276-4218
Mailing Address - Street 1:2316 E MEYER BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-1136
Mailing Address - Country:US
Mailing Address - Phone:816-276-4955
Mailing Address - Fax:816-276-4928
Practice Address - Street 1:802 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2544
Practice Address - Country:US
Practice Address - Phone:816-276-4955
Practice Address - Fax:816-276-4928
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESEARCH BELTON FOUNDATION SOLE M
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty