MEDICARE: JUNCTION CITY FAMILY DENTAL CARE L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	60712	KS

General Provider Information

NPI Number	:	1255563169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUNCTION CITY FAMILY DENTAL CARE L.L.C.

Provider Business Mailing Address
First Line	:	PO BOX 1082
Second Line	:
City	:	JUNCTION CITY
State	:	KS
Zip	:	66441-1082
Country	:	US
Telephone Number	:	785-762-4313
Fax Number	:

Provider Business Practice Location Address
First Line	:	1038 W ASH ST
Second Line	:
City	:	JUNCTION CITY
State	:	KS
Zip	:	66441-3462
Country	:	US
Telephone Number	:	785-762-7764
Fax Number	:	785-762-6500

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSH LARKIN
Credential	:	D.D.S.
Telephone Number	:	785-762-4313

Provider Enumeration Date	:	08/12/2009
Last Update Date	:	04/12/2011

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