| NPI | 1922536580 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRANT GASTINEAU Chief Officer 620-431-4823 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: KS 61398) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| 261QD0000X Clinic/Center, Dental | |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2017-05-26 |