Provider Demographics
NPI:1568138485
Name:FIRST AVENUE DENTAL, P.A.
Entity Type:Organization
Organization Name:FIRST AVENUE DENTAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEHMKUHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-225-5154
Mailing Address - Street 1:307 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ULYSSES
Mailing Address - State:KS
Mailing Address - Zip Code:67880-2132
Mailing Address - Country:US
Mailing Address - Phone:620-356-1221
Mailing Address - Fax:620-356-5204
Practice Address - Street 1:307 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:KS
Practice Address - Zip Code:67880-2132
Practice Address - Country:US
Practice Address - Phone:620-356-1221
Practice Address - Fax:620-356-5204
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST AVENUE DENTAL, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty