Provider Demographics
NPI:1952942880
Name:VALUDENTAL TRUMAN CORNERS RUSSELL LLC
Entity Type:Organization
Organization Name:VALUDENTAL TRUMAN CORNERS RUSSELL LLC
Other - Org Name:CELEBRATE DENTAL & BRACES GRANDVIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-459-0000
Mailing Address - Street 1:319 NE VIVION RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4510
Mailing Address - Country:US
Mailing Address - Phone:816-459-0000
Mailing Address - Fax:
Practice Address - Street 1:12414 S US HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-1733
Practice Address - Country:US
Practice Address - Phone:816-307-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty