Provider Demographics
NPI:1295558955
Name:EO INDEPENDENCE LLC
Entity type:Organization
Organization Name:EO INDEPENDENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NAON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:347-666-9014
Mailing Address - Street 1:3905 S LYNN CT
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-3337
Mailing Address - Country:US
Mailing Address - Phone:816-490-7330
Mailing Address - Fax:
Practice Address - Street 1:3905 S LYNN CT
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-3337
Practice Address - Country:US
Practice Address - Phone:816-490-7330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty