Organization Name: | FAMILY DENTISTRY |
NPI Number: | 1497012702 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KENNETH ELWYN BEAN (OWNER/ DENTIST) |
Mailing Address: | 113 S Main St Suite A Ulysses |
State: | KS US |
Postal Code: | 678802519 |
Phone Number: | 6204244499 |
Fax Number: | 6204244498 |
NPI Enumeration Date: | 04/12/2012 |
NPI Last Update Date: | 04/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 5513 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KS |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |