Provider Demographics
NPI:1700856762
Name:ATCHISON DENTAL ASSOCIATES PA
Entity Type:Organization
Organization Name:ATCHISON DENTAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:BLEY
Authorized Official - Last Name:REAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-367-0212
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-0399
Mailing Address - Country:US
Mailing Address - Phone:913-367-0212
Mailing Address - Fax:913-367-6214
Practice Address - Street 1:111 N 5TH ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-0399
Practice Address - Country:US
Practice Address - Phone:913-367-0212
Practice Address - Fax:913-367-6214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty