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General NPI Number Information
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NPI Number | 1114588639
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Entity Type | Organization
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Legal Business Name | EVOLVE FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 1133 COLLEGE AVE STE A103
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City | MANHATTAN
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State | KS
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Zip | 66502-2795
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Country | US
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Telephone | 785-539-0804
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Fax | 785-587-9810
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Provider Business Mailing Address
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Address Line | 1133 COLLEGE AVE STE A103
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City | MANHATTAN
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State | KS
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Zip | 66502-2795
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Country | US
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Telephone | 785-539-0804
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Fax | 785-587-9810
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. RYAN P GRIEVES
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Credential | DDS
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Telephone | 785-539-0804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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