Healthcare Provider Details

I. General information

NPI: 1447325212
Provider Name (Legal Business Name): RUFUS YOUNG BANDY III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CAISSON HILL ROAD
FT. RILEY KS
66442-5043
US

IV. Provider business mailing address

3005 CHERRY HILL
MANHATTAN KS
66503
US

V. Phone/Fax

Practice location:
  • Phone: 785-239-7241
  • Fax: 785-239-7245
Mailing address:
  • Phone: 785-239-4427
  • Fax: 785-239-7245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number60247
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: