Healthcare Provider Details

I. General information

NPI: 1013629716
Provider Name (Legal Business Name): DODGE CITY SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 N 14TH AVE
DODGE CITY KS
67801-2315
US

IV. Provider business mailing address

2520 N 14TH AVE
DODGE CITY KS
67801-2315
US

V. Phone/Fax

Practice location:
  • Phone: 620-227-7521
  • Fax:
Mailing address:
  • Phone: 620-227-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SHELIA K SCHUBERT
Title or Position: OFFICE MGR
Credential:
Phone: 620-227-7521