Provider Demographics
NPI:1952617557
Name:KATHI J. MATTHES D.D.S. , P.C.
Entity type:Organization
Organization Name:KATHI J. MATTHES D.D.S. , P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MATTHES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-524-3734
Mailing Address - Street 1:517 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2258
Mailing Address - Country:US
Mailing Address - Phone:816-524-3734
Mailing Address - Fax:816-524-9211
Practice Address - Street 1:517 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2258
Practice Address - Country:US
Practice Address - Phone:816-524-3734
Practice Address - Fax:816-524-9211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0160201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty