Healthcare Provider Details

I. General information

NPI: 1801278098
Provider Name (Legal Business Name): KATIE ASBJORNSON, D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 LAYTON ST
DODGE CITY KS
67801-2444
US

IV. Provider business mailing address

105 LAYTON ST
DODGE CITY KS
67801-2444
US

V. Phone/Fax

Practice location:
  • Phone: 620-371-6630
  • Fax: 620-371-6631
Mailing address:
  • Phone: 620-371-6630
  • Fax: 620-371-6631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number7220
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number60798
License Number StateKS

VIII. Authorized Official

Name: DR. KATIE ASBJORNSON
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 620-371-6630