| NPI | 1063571602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL WAGNER Office Manager 785-776-7242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KS 5333) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: KS 60385) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2020-08-22 |