Healthcare Provider Details

I. General information

NPI: 1407093958
Provider Name (Legal Business Name): MYCHEL TONI DOLEZAL R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MYCHEL TONI PFLUGHOEFT R.D.H.

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N DOUGLAS AVE
ELLSWORTH KS
67439-3216
US

IV. Provider business mailing address

315 E 3RD ST
ELLSWORTH KS
67439-3505
US

V. Phone/Fax

Practice location:
  • Phone: 785-472-3803
  • Fax: 785-472-3620
Mailing address:
  • Phone: 785-531-0427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number10973
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: