Provider Demographics
NPI:1558498642
Name:TWIETMEYER DENTISTRY PA
Entity Type:Organization
Organization Name:TWIETMEYER DENTISTRY PA
Other - Org Name:TWIETMEYER DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:TWIETMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-540-3171
Mailing Address - Street 1:PO BOX H
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:KS
Mailing Address - Zip Code:67025-0904
Mailing Address - Country:US
Mailing Address - Phone:316-540-3171
Mailing Address - Fax:316-542-9861
Practice Address - Street 1:107 N MAIN
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:KS
Practice Address - Zip Code:67025
Practice Address - Country:US
Practice Address - Phone:316-540-3171
Practice Address - Fax:316-542-9861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS57391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS420708OtherBLUE CROSS BLUE SHIELD
KS5739OtherDELTA DENTAL
KS5739OtherDELTA DENTAL