Provider Demographics
NPI:1124550777
Name:DENTAL HEALTH PARTNERS OF KANSAS
Entity Type:Organization
Organization Name:DENTAL HEALTH PARTNERS OF KANSAS
Other - Org Name:DENTAL HEALTH PARTNERS OF KANSAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-652-0000
Mailing Address - Street 1:1831 N ROCK ROAD CT STE 101
Mailing Address - Street 2:1223 N. ROCK ROAD BLDG. J
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1374
Mailing Address - Country:US
Mailing Address - Phone:316-652-0000
Mailing Address - Fax:316-652-0278
Practice Address - Street 1:1831 N ROCK ROAD CT STE 101
Practice Address - Street 2:1223 N. ROCK ROAD BLDG. J
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1374
Practice Address - Country:US
Practice Address - Phone:316-652-0000
Practice Address - Fax:316-652-0278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60439122300000X
KS6862122300000X
KS61184122300000X
122300000X
KS122300000X
KS71641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty