| NPI | 1871016089 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI HENDERSON Member 785-691-5223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2017-07-24 |