Provider Demographics
NPI:1891207122
Name:RIDGEVIEW FAMILY DENTAL PA
Entity Type:Organization
Organization Name:RIDGEVIEW FAMILY DENTAL PA
Other - Org Name:RIDGEVIEW FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-645-0079
Mailing Address - Street 1:1915 S OHIO CT STE 259
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-6602
Mailing Address - Country:US
Mailing Address - Phone:785-404-2070
Mailing Address - Fax:785-670-8471
Practice Address - Street 1:18130 W 119TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-9532
Practice Address - Country:US
Practice Address - Phone:913-828-2288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty