Healthcare Provider Details

I. General information

NPI: 1346440765
Provider Name (Legal Business Name): MICHAEL C. PUTNAM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 SE 29TH ST
TOPEKA KS
66605-2529
US

IV. Provider business mailing address

1910 SE 29TH ST
TOPEKA KS
66605-2529
US

V. Phone/Fax

Practice location:
  • Phone: 785-266-2929
  • Fax:
Mailing address:
  • Phone: 785-266-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5899
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: