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General NPI Number Information
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NPI Number | 1225748049
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Entity Type | Organization
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Legal Business Name | BLUE SKIES DENTAL LLC
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Dates
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Enumeration Date | 12/02/2022
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 4201 ANDERSON AVE STE A
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City | MANHATTAN
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State | KS
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Zip | 66503-7601
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Country | US
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Telephone | 785-537-4337
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Fax |
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Provider Business Mailing Address
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Address Line | 3863 HAYOVEL PL
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City | MANHATTAN
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State | KS
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Zip | 66503-8529
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Country | US
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Telephone | 785-392-0770
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRAVIS RAY WYMER
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Credential | DDS
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Telephone | 785-392-0770
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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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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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