Provider Demographics
NPI:1285682773
Name:CENTAL KANSAS DENTISTRY, PA
Entity Type:Organization
Organization Name:CENTAL KANSAS DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-472-3803
Mailing Address - Street 1:202 N DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:67439-3216
Mailing Address - Country:US
Mailing Address - Phone:785-472-3803
Mailing Address - Fax:785-472-3620
Practice Address - Street 1:202 N DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:KS
Practice Address - Zip Code:67439-3216
Practice Address - Country:US
Practice Address - Phone:785-472-3803
Practice Address - Fax:785-472-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS66521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS19253OtherBLUE CROSS BLUE SHIELD
KS100224500AMedicare ID - Type Unspecified