Provider Demographics
NPI:1093076226
Name:CLAY CENTER FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:CLAY CENTER FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-632-3126
Mailing Address - Street 1:714 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67432-1529
Mailing Address - Country:US
Mailing Address - Phone:785-632-3126
Mailing Address - Fax:
Practice Address - Street 1:714 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CLAY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67432-1529
Practice Address - Country:US
Practice Address - Phone:785-632-3126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty