Provider Demographics
NPI:1376254607
Name:BRIAN L. HEADRICK DDS
Entity Type:Organization
Organization Name:BRIAN L. HEADRICK DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEADRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-873-2802
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:MEADE
Mailing Address - State:KS
Mailing Address - Zip Code:67864-0516
Mailing Address - Country:US
Mailing Address - Phone:620-873-2802
Mailing Address - Fax:620-873-5308
Practice Address - Street 1:120 S FOWLER ST
Practice Address - Street 2:
Practice Address - City:MEADE
Practice Address - State:KS
Practice Address - Zip Code:67864-6404
Practice Address - Country:US
Practice Address - Phone:620-873-2802
Practice Address - Fax:620-873-5308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental