Provider Demographics
NPI:1376914127
Name:EAST 29TH STREET DENTAL CENTER, LLC
Entity Type:Organization
Organization Name:EAST 29TH STREET DENTAL CENTER, LLC
Other - Org Name:TOPEKA DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-916-5036
Mailing Address - Street 1:2037 SE 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66605-2457
Mailing Address - Country:US
Mailing Address - Phone:785-267-9500
Mailing Address - Fax:785-328-4729
Practice Address - Street 1:2037 SE 29TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605
Practice Address - Country:US
Practice Address - Phone:785-267-9500
Practice Address - Fax:785-328-4729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty