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NPI Code Detail

MEDICARE: LITTLE APPLE PEDIATRIC DENTIST

MEDICARE: LITTLE APPLE PEDIATRIC DENTIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric Dentistry60385KS
21223P0221XPediatric Dentistry5333KS

General Provider Information

NPI Number : 1063571602
Entity Type Code : Organization
Provider Name (Legal Business Name) : LITTLE APPLE PEDIATRIC DENTIST
Provider Business Mailing Address
First Line : 1133 COLLEGE AVE
Second Line : BLDG. D LOWER LEVEL
City : MANHATTAN
State : KS
Zip : 66502-2770
Country : US
Telephone Number : 785-776-7242
Fax Number : 785-776-5862
Provider Business Practice Location Address
First Line : 1133 COLLEGE AVE
Second Line : BLDG. D LOWER LEVEL
City : MANHATTAN
State : KS
Zip : 66502-2770
Country : US
Telephone Number : 785-776-7242
Fax Number : 785-776-5862
Authorized Official
Title or Position : OFFICE MANAGER
Name : MRS. CAROL WAGNER
Credential :
Telephone Number : 785-776-7242
Provider Enumeration Date : 12/08/2006
Last Update Date : 08/22/2020

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Directions to “LITTLE APPLE PEDIATRIC DENTIST ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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