Provider Demographics
NPI:1598811671
Name:ACCENT DENTAL L.L.C.
Entity Type:Organization
Organization Name:ACCENT DENTAL L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:H.R.
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:I
Authorized Official - Last Name:FERRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-231-2871
Mailing Address - Street 1:2002 S. ROUSE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762
Mailing Address - Country:US
Mailing Address - Phone:620-231-2871
Mailing Address - Fax:620-231-3550
Practice Address - Street 1:204 STATE STREET
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701
Practice Address - Country:US
Practice Address - Phone:620-223-0130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6182261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200264670DMedicaid