Provider Demographics
NPI:1235111667
Name:HAROLD A SMALL DDS PA
Entity Type:Organization
Organization Name:HAROLD A SMALL DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-845-6417
Mailing Address - Street 1:3 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:KS
Mailing Address - Zip Code:67022-1531
Mailing Address - Country:US
Mailing Address - Phone:620-845-6417
Mailing Address - Fax:620-845-6422
Practice Address - Street 1:3 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:KS
Practice Address - Zip Code:67022-1531
Practice Address - Country:US
Practice Address - Phone:620-845-6417
Practice Address - Fax:620-845-6422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6646122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty