Provider Demographics
NPI:1740423003
Name:RAWLINS COUNTY DENTAL CLINIC FUND
Entity Type:Organization
Organization Name:RAWLINS COUNTY DENTAL CLINIC FUND
Other - Org Name:RAWLINS COUNTY DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:POCHOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-626-8290
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:ATWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:67730-0177
Mailing Address - Country:US
Mailing Address - Phone:785-626-8290
Mailing Address - Fax:785-626-8332
Practice Address - Street 1:515 STATE ST
Practice Address - Street 2:
Practice Address - City:ATWOOD
Practice Address - State:KS
Practice Address - Zip Code:67730-1930
Practice Address - Country:US
Practice Address - Phone:785-626-8290
Practice Address - Fax:785-626-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60622261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental