Provider Demographics
NPI:1003250713
Name:PAUL W HEATH, DDS
Entity Type:Organization
Organization Name:PAUL W HEATH, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:I
Authorized Official - Last Name:FULKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-234-5410
Mailing Address - Street 1:2714 NW TOPEKA BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66617-1147
Mailing Address - Country:US
Mailing Address - Phone:785-234-5410
Mailing Address - Fax:785-234-9274
Practice Address - Street 1:2714 NW TOPEKA BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66617-1147
Practice Address - Country:US
Practice Address - Phone:785-234-5410
Practice Address - Fax:785-234-9274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS71461223G0001X
KS53631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100383600BMedicaid
KS100095890BMedicaid