Provider Demographics
NPI:1164567012
Name:BILL G. GOBLE, D.D.S., P.A.
Entity Type:Organization
Organization Name:BILL G. GOBLE, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:GOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:WIFE
Authorized Official - Phone:785-271-5111
Mailing Address - Street 1:2445 SW WANAMAKER RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-5470
Mailing Address - Country:US
Mailing Address - Phone:785-271-5111
Mailing Address - Fax:785-271-5556
Practice Address - Street 1:2445 SW WANAMAKER RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-5470
Practice Address - Country:US
Practice Address - Phone:785-271-5111
Practice Address - Fax:785-271-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4087586801Medicaid
KS1477542587OtherNPI INDIVIDUAL NUMBER
KS4087586801Medicaid