| NPI | 1245367077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY R LUNDGRIN President 785-825-5473 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 4696) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 6929) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2020-08-22 |