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General NPI Number Information
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NPI Number | 1053758284
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Entity Type | Organization
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Legal Business Name | COVENANT FAMILY DENTAL CARE
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Dates
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Enumeration Date | 05/29/2013
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Last Update Date | 05/29/2013
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Provider Practice Location Address
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Address Line | 611 E IRON AVE
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City | SALINA
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State | KS
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Zip | 67401-3035
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Country | US
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Telephone | 785-404-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 4428 SW WANAMAKER RD
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City | TOPEKA
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State | KS
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Zip | 66610-1340
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Country | US
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Telephone | 785-250-6939
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. VERMELLE LONNISHA BROWN-GHOSTON
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Credential | DDS
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Telephone | 785-250-6939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | KS
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