Provider Demographics
NPI:1376005124
Name:CAMBRIDGE FAMILY DENTISTRY, P.A.
Entity Type:Organization
Organization Name:CAMBRIDGE FAMILY DENTISTRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-687-2110
Mailing Address - Street 1:2020 N WEBB RD STE 301
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3410
Mailing Address - Country:US
Mailing Address - Phone:316-687-2110
Mailing Address - Fax:316-636-9539
Practice Address - Street 1:2020 N WEBB RD STE 301
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3410
Practice Address - Country:US
Practice Address - Phone:316-687-2110
Practice Address - Fax:316-636-9539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental