Provider Demographics
NPI:1679668628
Name:SENECA DENTAL CLINIC, INC.
Entity Type:Organization
Organization Name:SENECA DENTAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-226-6149
Mailing Address - Street 1:509 NEMAHA ST
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:KS
Mailing Address - Zip Code:66538-1758
Mailing Address - Country:US
Mailing Address - Phone:785-336-6149
Mailing Address - Fax:785-336-0050
Practice Address - Street 1:509 NEMAHA ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:KS
Practice Address - Zip Code:66538-1758
Practice Address - Country:US
Practice Address - Phone:785-336-6149
Practice Address - Fax:785-336-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS603331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS=========OtherTAX IDENTIFICATION NUMBER