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CUSTOM DENTAL OF HARRISONVILLE, PLLC
NPI 1215231360
Dentist - General Practice in Harrisonville, MO

Active since January 04, 2011CLIA 26D2326076 · Waiver
2100 N 291 HWY, HARRISONVILLE, MO 64701(405) 282-6440(405) 282-6785 Get Directions Write a Review

NPPES record last updated: January 4, 2011. Verified against the NPPES registry weekly; last sync: October 04, 2026.

About Custom Dental Of Harrisonville, Pllc NPPES

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

CUSTOM DENTAL OF HARRISONVILLE, PLLC (NPI 1215231360) is a healthcare organization registered as a general practice in Harrisonville, Missouri and active in the NPI registry since January 2011. The organization holds a CLIA Waiver certificate valid through June 25, 2027 and lists Chad Wassink, Dentist, as its authorized official.

NPPES Registry Identity

NPI1215231360
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameCUSTOM DENTAL OF HARRISONVILLE, PLLC
Location Address2100 N 291 HWYHarrisonville, MO 64701-1226
Mailing Address2100 N 291 HwyHarrisonville, MO 64701-1226 · (405) 282-6440 · Fax (405) 282-6785
Phone(405) 282-6440
Fax(405) 282-6785
Organization SubpartNo
Authorized OfficialChad WassinkDentist · (405) 282-6440
Enumeration DateJanuary 4, 2011
✔ NPI 1215231360 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in OK · 6123
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
2100 N 291 HWY, Harrisonville, MO 64701
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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

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 26D2326076

Custom Dental Of Harrisonville · Harrisonville, MO
Active · expires Jun 25, 2027
CLIA Number26D2326076
Laboratory TypePractitioner Other
Certificate Effective DateJune 26, 2025
Certificate Expiration DateJune 25, 2027
Laboratory DirectorChad J. Wassink
Laboratory Phone(816) 884-1005
Laboratory LocationCustom Dental Of Harrisonville2100 N State Route 291 Hwy, Harrisonville, MO 64701
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

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 Custom Dental Of Harrisonville, PLLC's NPI number?

The NPI number for Custom Dental Of Harrisonville, PLLC is 1215231360. It was assigned to this organization in the NPPES registry on January 4, 2011.

Where is Custom Dental Of Harrisonville, PLLC located?

Custom Dental Of Harrisonville, PLLC is located at 2100 N 291 Hwy, Harrisonville, MO 64701. The listed phone number is (405) 282-6440.

What is Custom Dental Of Harrisonville, PLLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Does Custom Dental Of Harrisonville, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 26D2326076) is associated with this NPI, valid through June 25, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Custom Dental Of Harrisonville, PLLC was last updated on January 4, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.