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SUMMIT PEDIATRIC DENTISTRY
NPI 1053848374
Dentist - Pediatric Dentistry in Lees Summit, MO

Active since May 17, 2017
24 NW CHIPMAN RD STE B, LEES SUMMIT, MO 64063(816) 256-0073 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 21, 2022, May 17, 2017 (2 updates tracked since 2017).

About Summit Pediatric Dentistry NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SUMMIT PEDIATRIC DENTISTRY (NPI 1053848374) is a healthcare organization registered as a pediatric dentistry in Lees Summit, Missouri and active in the NPI registry since May 2017. The organization lists Moncy Mathew, Owner/dentist, as its authorized official.

NPPES Registry Identity

NPI1053848374
Entity TypeOrganization
Primary Taxonomy1223P0221X
Legal Business NameSUMMIT PEDIATRIC DENTISTRY
Location Address24 NW CHIPMAN RD STE BLees Summit, MO 64063-1929
Mailing Address24 Nw Chipman Rd Ste BLees Summit, MO 64063-1929 · (816) 256-0073
Phone(816) 256-0073
Organization SubpartNo
Authorized OfficialMoncy MathewOwner/dentist · (816) 256-0073
Enumeration DateMay 17, 2017
Last NPPES UpdateJuly 21, 20222 updates tracked since enumeration
✔ NPI 1053848374 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
License✔ Licensed in MO · 2006037222
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
24 NW CHIPMAN RD STE B, Lees Summit, MO 64063
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Other Identifiers 1

Medicaid1841474293MO

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Summit Pediatric Dentistry's NPI number?

The NPI number for Summit Pediatric Dentistry is 1053848374. It was assigned to this organization in the NPPES registry on May 17, 2017.

Where is Summit Pediatric Dentistry located?

Summit Pediatric Dentistry is located at 24 NW Chipman Rd Ste B, Lees Summit, MO 64063. The listed phone number is (816) 256-0073.

What is Summit Pediatric Dentistry's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

When was this NPI record last updated?

The NPPES record for Summit Pediatric Dentistry was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.