Provider Demographics
NPI:1417916149
Name:DENTAL CARE PA
Entity Type:Organization
Organization Name:DENTAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BACHU
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-235-6219
Mailing Address - Street 1:1835 NW TOPEKA BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66608
Mailing Address - Country:US
Mailing Address - Phone:785-235-6219
Mailing Address - Fax:785-232-9410
Practice Address - Street 1:1835 NW TOPEKA BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66608
Practice Address - Country:US
Practice Address - Phone:785-235-6219
Practice Address - Fax:785-232-9410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS62241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS008845OtherBCBS
627337OtherUNITED CONCORDIA