Basic Information
| Provider Information | |||||||||
| NPI: | 1003804048 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUYETT | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4627 SHAWNEE DR | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661063648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136771004 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4627 SHAWNEE DR | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661063648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136771004 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2005 | ||||||||
| LastUpdateDate: | 09/11/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 60026 | KS | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 40-870774-01 | 05 | KS | MEDICAID |