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General NPI Number Information
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NPI Number | 1942744107
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Entity Type | Organization
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Legal Business Name | AD ASTRA FAMILY DENTISTRY, L.L.C.
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 1271 SW WOODHULL ST STE A
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City | TOPEKA
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State | KS
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Zip | 66604-1849
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Country | US
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Telephone | 785-286-7541
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Fax | 785-783-2962
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Provider Business Mailing Address
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Address Line | 5963 SW 31ST TER
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City | TOPEKA
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State | KS
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Zip | 66614-4123
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Country | US
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Telephone | 785-286-7541
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Fax | 785-783-2962
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. ERIC C JOHNSON
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Credential | DDS
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Telephone | 785-220-6346
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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 | 60471
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License Number State | KS
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