Provider Demographics
NPI:1245645548
Name:M. CONRAD JOURNEE, DDS, LLC
Entity type:Organization
Organization Name:M. CONRAD JOURNEE, DDS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CONRAD
Authorized Official - Last Name:JOURNEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-682-2595
Mailing Address - Street 1:726 SHAWNEE ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-1804
Mailing Address - Country:US
Mailing Address - Phone:913-682-2595
Mailing Address - Fax:913-682-2595
Practice Address - Street 1:726 SHAWNEE ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-1804
Practice Address - Country:US
Practice Address - Phone:913-682-2595
Practice Address - Fax:913-682-2595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60997122300000X
KS608421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty