Provider Demographics
NPI:1336207448
Name:ANTIOCH DENTAL GROUP
Entity Type:Organization
Organization Name:ANTIOCH DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-452-9700
Mailing Address - Street 1:5420 NE ANTIOCH ROAD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119
Mailing Address - Country:US
Mailing Address - Phone:816-452-9700
Mailing Address - Fax:816-452-9779
Practice Address - Street 1:5420 NE ANTIOCH ROAD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64119
Practice Address - Country:US
Practice Address - Phone:816-452-9700
Practice Address - Fax:816-452-9779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty