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General NPI Number Information
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NPI Number | 1194276238
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Entity Type | Organization
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Legal Business Name | MID KANSAS DENTAL, LLC
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 11/23/2022
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Provider Practice Location Address
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Address Line | 801 N MAPLE ST
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City | MCPHERSON
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State | KS
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Zip | 67460-3103
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Country | US
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Telephone | 620-241-6512
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Fax | 620-241-8568
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Provider Business Mailing Address
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Address Line | 801 N MAPLE ST
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City | MCPHERSON
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State | KS
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Zip | 67460-3103
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Country | US
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Telephone | 620-241-6512
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Fax | 620-241-8568
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LESLEE MILLER
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Credential |
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Telephone | 620-241-6512
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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 | KS60689
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License Number State | KS
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