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General NPI Number Information
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NPI Number | 1780224121
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Entity Type | Organization
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Legal Business Name | FLINTHILLSDENTALPA
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Dates
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Enumeration Date | 01/14/2020
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Last Update Date | 01/14/2020
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Provider Practice Location Address
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Address Line | 104 S. DE SMET LN. STE. 6
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City | ST MARYS
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State | KS
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Zip | 66536
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Country | US
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Telephone | 785-321-3455
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Fax | 785-321-3466
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Provider Business Mailing Address
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Address Line | PO BOX 129
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City | SAINT MARYS
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State | KS
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Zip | 66536-0129
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Country | US
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Telephone | 785-321-3455
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Fax | 785-321-3466
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ANTOINETTE CANCELADA
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Credential |
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Telephone | 785-321-3455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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