Provider Demographics
NPI:1215034442
Name:CHARLES E LEINS DDS PA
Entity Type:Organization
Organization Name:CHARLES E LEINS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ELLSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-782-1420
Mailing Address - Street 1:234 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-4425
Mailing Address - Country:US
Mailing Address - Phone:913-782-1420
Mailing Address - Fax:913-782-1489
Practice Address - Street 1:234 S CHERRY
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061
Practice Address - Country:US
Practice Address - Phone:913-782-1420
Practice Address - Fax:913-782-1489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty