Provider Demographics
NPI:1740772722
Name:IDEUS, NATHAN A (DDS)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:A
Last Name:IDEUS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 NW TOPEKA BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66608-1892
Mailing Address - Country:US
Mailing Address - Phone:785-235-6219
Mailing Address - Fax:785-232-9410
Practice Address - Street 1:1835 NW TOPEKA BLVD STE 111
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66608-1892
Practice Address - Country:US
Practice Address - Phone:785-235-6219
Practice Address - Fax:785-232-9410
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS613551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice