| NPI | 1003250713 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA I FULKERSON Office Manager 785-234-5410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 7146) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 5363) |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2013-04-24 |