| NPI | 1104214816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRETCHEN EDWARDS Office Manager 785-856-0117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: KS 6357) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: KS 1885) |
| 1223E0200X Dentist, Endodontics (Licence: KS 6944) | |
| 1223P0300X Dentist, Periodontics (Licence: KS 60071) | |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2015-01-05 |