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General NPI Number Information
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NPI Number | 1871016089
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Entity Type | Organization
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Legal Business Name | TOPEKA PEDIATRIC DENTISTRY LLC
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 07/24/2017
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Provider Practice Location Address
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Address Line | 2445 SW WANAMAKER RD STE 103
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City | TOPEKA
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State | KS
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Zip | 66614-5470
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Country | US
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Telephone | 785-691-5223
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Fax |
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Provider Business Mailing Address
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Address Line | 4601 W 6TH ST STE A
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City | LAWRENCE
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State | KS
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Zip | 66049-4129
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Country | US
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Telephone | 785-691-5223
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. KELLI HENDERSON
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Credential | DDS
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Telephone | 785-691-5223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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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 | 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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