Provider Demographics
NPI:1801961164
Name:DENTISTRY ON DOUGLAS STREET LLC
Entity type:Organization
Organization Name:DENTISTRY ON DOUGLAS STREET LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-524-1337
Mailing Address - Street 1:103 NE DOUGLAS STREET
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2037
Mailing Address - Country:US
Mailing Address - Phone:816-524-1337
Mailing Address - Fax:816-525-7640
Practice Address - Street 1:103 NE DOUGLAS STREET
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2037
Practice Address - Country:US
Practice Address - Phone:816-524-1337
Practice Address - Fax:816-525-7640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE0154181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty