Provider Demographics
NPI:1740617612
Name:GREGORY J PARTRIDGE DDS, ESTATE
Entity Type:Organization
Organization Name:GREGORY J PARTRIDGE DDS, ESTATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-238-7426
Mailing Address - Street 1:841 S HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-3005
Mailing Address - Country:US
Mailing Address - Phone:316-681-1530
Mailing Address - Fax:316-682-5231
Practice Address - Street 1:841 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-3005
Practice Address - Country:US
Practice Address - Phone:316-681-1530
Practice Address - Fax:316-682-5231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10222990AMedicaid