Provider Demographics
NPI:1114241494
Name:COMMUNITY DENTAL CLINIC
Entity Type:Organization
Organization Name:COMMUNITY DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LENISKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:260-768-7918
Mailing Address - Street 1:7750 W 200 S
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:IN
Mailing Address - Zip Code:46571-9436
Mailing Address - Country:US
Mailing Address - Phone:260-768-7918
Mailing Address - Fax:260-768-7983
Practice Address - Street 1:7750 W 200 S
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:IN
Practice Address - Zip Code:46571-9436
Practice Address - Country:US
Practice Address - Phone:260-768-7918
Practice Address - Fax:260-768-7983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty