Provider Demographics
NPI:1649638891
Name:METROPOLITAN DENTAL ASSOCIATES, PC
Entity type:Organization
Organization Name:METROPOLITAN DENTAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ANIIKA
Authorized Official - Middle Name:R
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-523-7788
Mailing Address - Street 1:751 E. 63RD ST
Mailing Address - Street 2:SUITE 217
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110
Mailing Address - Country:US
Mailing Address - Phone:816-523-7788
Mailing Address - Fax:816-444-1175
Practice Address - Street 1:751 E 63RD ST
Practice Address - Street 2:SUITE 217
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-3385
Practice Address - Country:US
Practice Address - Phone:816-523-7788
Practice Address - Fax:816-444-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080284441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty