Provider Demographics
NPI:1144661851
Name:DYKHOUSE ORTHODONTICS
Entity type:Organization
Organization Name:DYKHOUSE ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:DYKHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-229-0444
Mailing Address - Street 1:1300 S OUTER RD
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-3062
Mailing Address - Country:US
Mailing Address - Phone:816-229-0444
Mailing Address - Fax:
Practice Address - Street 1:1300 S OUTER RD
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3062
Practice Address - Country:US
Practice Address - Phone:816-229-0444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty