Healthcare Provider Details

I. General information

NPI: 1740423003
Provider Name (Legal Business Name): RAWLINS COUNTY DENTAL CLINIC FUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 STATE ST
ATWOOD KS
67730-1930
US

IV. Provider business mailing address

PO BOX 177
ATWOOD KS
67730-0177
US

V. Phone/Fax

Practice location:
  • Phone: 785-626-8290
  • Fax: 785-626-8332
Mailing address:
  • Phone: 785-626-8290
  • Fax: 785-626-8332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number60622
License Number StateKS

VIII. Authorized Official

Name: DEBRA POCHOP
Title or Position: CEO
Credential:
Phone: 785-626-8290