Healthcare Provider Details

I. General information

NPI: 1457920548
Provider Name (Legal Business Name): SABETHA DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 S US OLD HIGHWAY 75
SABETHA KS
66534
US

IV. Provider business mailing address

1309 S US OLD HIGHWAY 75
SABETHA KS
66534
US

V. Phone/Fax

Practice location:
  • Phone: 785-284-2323
  • Fax: 785-284-0075
Mailing address:
  • Phone: 785-284-2323
  • Fax: 785-284-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIZABETH LOUISE TEDMAN
Title or Position: DENTIST-OWNER
Credential: DMD
Phone: 785-284-2323