State Avenue Dental LLC

NPI #1881959278 in Kansas City, Kansas

Provider Information

NPI Number: 1881959278
Entity Type: Organization
Organization Name: State Avenue Dental LLC
Primary Specialty: Dentist
Enumeration Date: Jul 11, 2012
Last Updated: Jul 11, 2012

Practice Location

Address: 7933 STATE AVE
Address 2: SUITE 101
City: Kansas City
State: Kansas
ZIP Code: 66112-2468
Phone: (913) 213-6973

Authorized Official

Name: DR. MATTHEW FOGG TINGEY, DDS
Title: DENTIST
Phone: (913) 213-6973

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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