Provider Demographics
NPI:1578654612
Name:WAMEGO DENTAL CENTER, P.A.
Entity Type:Organization
Organization Name:WAMEGO DENTAL CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-456-2330
Mailing Address - Street 1:503 ELM
Mailing Address - Street 2:BOX 26, SUITE 1
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547-0026
Mailing Address - Country:US
Mailing Address - Phone:785-456-2330
Mailing Address - Fax:785-456-9740
Practice Address - Street 1:503 ELM
Practice Address - Street 2:BOX 26, SUITE 1
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-0026
Practice Address - Country:US
Practice Address - Phone:785-456-2330
Practice Address - Fax:785-456-9740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty