Healthcare Provider Details

I. General information

NPI: 1992968184
Provider Name (Legal Business Name): CHAD ALLAN OHNMACHT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 WILLIAMS ST
GREAT BEND KS
67530-2542
US

IV. Provider business mailing address

1701 WILLIAMS ST
GREAT BEND KS
67530-2542
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-1941
  • Fax: 620-792-2766
Mailing address:
  • Phone: 620-792-1941
  • Fax: 620-792-2766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60558
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: