Provider Demographics
NPI:1033661988
Name:DENTAL PROFESSIONALS LLC
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:
Authorized Official - Last Name:YSIDRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-788-2118
Mailing Address - Street 1:900 E MEADOWLARK BLVD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-3465
Mailing Address - Country:US
Mailing Address - Phone:316-788-2118
Mailing Address - Fax:316-789-9098
Practice Address - Street 1:900 E MEADOWLARK BLVD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-3465
Practice Address - Country:US
Practice Address - Phone:316-788-2118
Practice Address - Fax:316-789-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty