| NPI | 1235704289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLETON ALLEN CALDWELL Owner/Dentist 316-208-9061 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2025-07-09 |