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General NPI Number Information
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NPI Number | 1992865612
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Entity Type | Organization
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Legal Business Name | CAROL M. YSIDRO, D.D.S.,P.A.
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 900 E. MEADOWLARK
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City | DERBY
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State | KS
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Zip | 67037-5258
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Country | US
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Telephone | 316-788-2118
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Fax | 316-789-9098
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Provider Business Mailing Address
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Address Line | PO BOX 1258 900 E. MEADOWLARK
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City | DERBY
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State | KS
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Zip | 67037-5258
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Country | US
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Telephone | 316-788-2118
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Fax | 316-789-9098
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MR. MONTE YSIDRO
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Credential |
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Telephone | 316-788-2118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 60024
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License Number State | KS
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