Provider Demographics
NPI:1801216395
Name:PERSONALIZED FAMILY DENTAL CARE OF TOPEKA, P.A.
Entity Type:Organization
Organization Name:PERSONALIZED FAMILY DENTAL CARE OF TOPEKA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-749-2525
Mailing Address - Street 1:2215 SW WESTPORT DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-1926
Mailing Address - Country:US
Mailing Address - Phone:785-228-0100
Mailing Address - Fax:785-228-1569
Practice Address - Street 1:2215 SW WESTPORT DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-1926
Practice Address - Country:US
Practice Address - Phone:785-228-0100
Practice Address - Fax:785-228-1569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty