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General NPI Number Information
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NPI Number | 1053995613
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Entity Type | Organization
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Legal Business Name | CARRIAGE FAMILY DENTAL, PA
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 02/14/2023
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Provider Practice Location Address
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Address Line | 726 SHAWNEE ST
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City | LEAVENWORTH
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State | KS
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Zip | 66048-1804
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Country | US
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Telephone | 913-682-2595
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Fax |
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Provider Business Mailing Address
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Address Line | 726 SHAWNEE ST
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City | LEAVENWORTH
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State | KS
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Zip | 66048-1804
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Country | US
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Telephone | 913-682-2595
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MGR
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Name | LIZZIE YOUNG
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Credential |
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Telephone | 405-233-8873
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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 |
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