Provider Demographics
NPI:1184235517
Name:TWIN CREEKS FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:TWIN CREEKS FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-868-6269
Mailing Address - Street 1:10560 N AMBASSADOR DR STE 200
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153-1591
Mailing Address - Country:US
Mailing Address - Phone:816-891-8091
Mailing Address - Fax:816-891-9343
Practice Address - Street 1:10560 N AMBASSADOR DR STE 200
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-1591
Practice Address - Country:US
Practice Address - Phone:816-891-8091
Practice Address - Fax:816-891-9343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental