Provider Demographics
NPI:1760690531
Name:PEDIATRIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:D
Authorized Official - Last Name:GAUSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:620-663-5044
Mailing Address - Street 1:1311 WHEATLAND DR
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-5667
Mailing Address - Country:US
Mailing Address - Phone:620-663-5044
Mailing Address - Fax:620-663-3044
Practice Address - Street 1:1311 WHEATLAND DR
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-5667
Practice Address - Country:US
Practice Address - Phone:620-663-5044
Practice Address - Fax:620-663-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty