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General NPI Number Information
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NPI Number | 1710588900
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Entity Type | Organization
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Legal Business Name | PRAIRIE ROCK DENTAL, P.A.
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Dates
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Enumeration Date | 11/04/2020
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 8123 E HARRY ST
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City | WICHITA
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State | KS
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Zip | 67207-4603
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Country | US
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Telephone | 316-686-3397
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Fax |
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Provider Business Mailing Address
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Address Line | 1915 S OHIO CT STE 259
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City | SALINA
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State | KS
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Zip | 67401-6602
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Country | US
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Telephone | 785-404-2070
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Fax |
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Authorized Official
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Title or Position | COO
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Name | SCOTT GUEST
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Credential |
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Telephone | 913-645-0079
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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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