Provider Demographics
NPI:1275199168
Name:FIRST AVENUE DENTAL, P.A.
Entity Type:Organization
Organization Name:FIRST AVENUE DENTAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEHMKUHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-371-6630
Mailing Address - Street 1:23 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2720
Mailing Address - Country:US
Mailing Address - Phone:620-604-9279
Mailing Address - Fax:620-417-9616
Practice Address - Street 1:23 E 11TH ST
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2720
Practice Address - Country:US
Practice Address - Phone:620-604-9279
Practice Address - Fax:620-417-9616
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST AVENUE DENTAL, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-15
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty