Provider Demographics
NPI:1548554231
Name:BAGLEY, AMY SUZANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:SUZANNE
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 N REVERE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-3965
Mailing Address - Country:US
Mailing Address - Phone:816-505-9767
Mailing Address - Fax:816-505-1621
Practice Address - Street 1:6300 N REVERE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-3965
Practice Address - Country:US
Practice Address - Phone:816-505-9767
Practice Address - Fax:816-505-1621
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011014450122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist