MEDICARE: JUNCTION CITY FAMILY DENTISTRY, LLC

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
1	1223G0001X	General Practice Dentistry	5656	KS

General Provider Information

NPI Number	:	1093737983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUNCTION CITY FAMILY DENTISTRY, LLC

Provider Business Mailing Address
First Line	:	1038 W ASH ST
Second Line	:
City	:	JUNCTION CITY
State	:	KS
Zip	:	66441-3462
Country	:	US
Telephone Number	:	785-762-4313
Fax Number	:

Provider Business Practice Location Address
First Line	:	1038 W ASH ST
Second Line	:
City	:	JUNCTION CITY
State	:	KS
Zip	:	66441-3462
Country	:	US
Telephone Number	:	785-762-4313
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES KEVIN BONGERS
Credential	:
Telephone Number	:	785-762-4313

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	08/22/2020

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