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General NPI Number Information
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NPI Number | 1114481322
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Entity Type | Organization
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Legal Business Name | GODDARD ORTHODONTICS PA
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Dates
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Enumeration Date | 01/22/2019
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Last Update Date | 01/22/2019
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Provider Practice Location Address
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Address Line | 19931 W KELLOGG DR
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City | GODDARD
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State | KS
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Zip | 67052-8863
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Country | US
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Telephone | 316-722-6717
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Fax |
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Provider Business Mailing Address
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Address Line | 308 N HARRISON AVE
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City | SEDGWICK
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State | KS
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Zip | 67135-9477
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Country | US
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Telephone | 316-652-5321
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Fax | 316-722-1371
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. LEVI HANSEN
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Credential | DMD, MS
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Telephone | 316-722-6717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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