CLAYCOMO DENTAL LLC NPI 1942746896

Clinic/Center (Dental) in Kansas City, MO

NPI 1942746896 Organization Clinic/Center Dental

About CLAYCOMO DENTAL LLC

Claycomo Dental Llc is a provider established in Kansas City, Missouri specializing in clinic/center (dental) . The NPI number of Claycomo Dental Llc is 1942746896 and was assigned on January 2017. The practitioner's primary taxonomy code is 261QD0000X with license number 2009016386 (MO). The provider is registered as an organization and their NPI record was last updated 5 years ago. The authorized official of this NPI record is Bryan Shewanick (Member)

NPI

1942746896

Provider NameCLAYCOMO DENTAL LLC
Provider Location Address244 E US HIGHWAY 69 SUITE 101 KANSAS CITY, MO 64119
Provider Mailing Address244 E US HIGHWAY 69 SUITE 101 KANSAS CITY, MO 64119
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date01-17-2017
Last Update Date01-17-2017


Primary Taxonomy

Taxonomy Code261QD0000X
ClassificationClinic/Center
TypeAmbulatory Health Care Facilities
SpecializationDental
License No.2009016386
License StateMO

Business Address

CLAYCOMO DENTAL LLC
244 E US HIGHWAY 69
SUITE 101
KANSAS CITY, MO
ZIP 64119
Phone: (816) 454-1313

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Mailing Address

CLAYCOMO DENTAL LLC
244 E US HIGHWAY 69
SUITE 101
KANSAS CITY, MO
ZIP 64119
Phone:



Authorized Official

Authorized Official Name BRYAN SHEWANICK
Authorized Official TitleMEMBER
Authorized Official Phone(816) 454-1313

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental2014022711MONo

Taxonomy Description: Not Available

2261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental2014018762MONo

Taxonomy Description: Not Available

Other Providers at the same location


The following 5 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1891729489 CHERYL LOUISE GOLLADAY D.C.
Individual
Chiropractor244 E US HIGHWAY 69 STE. 202
KANSAS CITY, MO 64119
(816) 455-3119
1922011055ADVANCED HEALTH CHIROPRACTIC, INC
Organization
Chiropractor244 E US HIGHWAY 69 #202
KANSAS CITY, MO 64119
(816) 453-1198
1023297488DR. NOELLE PETIT VAN METER B.S., D.C.
Individual
Chiropractor244 E US HIGHWAY 69 SUITE 202
KANSAS CITY, MO 64119
(816) 453-1198
1205255460CLAYCOMO DENTAL GROUP LLC
Organization
Clinic/Center (Dental)244 E US HIGHWAY 69 SUITE 101
KANSAS CITY, MO 64119
(816) 454-1313
1639268972JAMES B THEILEN DDS &JERRY E THEILEN DDS PC
Organization
Dentist244 E US HIGHWAY 69 SUITE 101
CLAYCOMO, MO 64119
(816) 454-1313

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.