Provider Demographics
NPI:1497970685
Name:AUGUSTA FAMILY DENISTRY PA
Entity Type:Organization
Organization Name:AUGUSTA FAMILY DENISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:MITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:316-775-2482
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:401 STATE STREET
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010-0567
Mailing Address - Country:US
Mailing Address - Phone:316-775-2482
Mailing Address - Fax:316-775-5068
Practice Address - Street 1:401 STATE ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-1135
Practice Address - Country:US
Practice Address - Phone:316-775-2482
Practice Address - Fax:316-775-5068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty