Provider Demographics
NPI:1790563559
Name:TOPEKA PRODENTAL
Entity Type:Organization
Organization Name:TOPEKA PRODENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARDELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MADEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-273-2922
Mailing Address - Street 1:2930 SW WANAMAKER DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4116
Mailing Address - Country:US
Mailing Address - Phone:785-273-2922
Mailing Address - Fax:785-272-1404
Practice Address - Street 1:2930 SW WANAMAKER DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-4116
Practice Address - Country:US
Practice Address - Phone:785-273-2922
Practice Address - Fax:785-272-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty