Provider Demographics
NPI:1891729943
Name:GAGE CENTER DENTAL GROUP PA
Entity Type:Organization
Organization Name:GAGE CENTER DENTAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-273-4770
Mailing Address - Street 1:1271 SW WOODHULL ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1635
Mailing Address - Country:US
Mailing Address - Phone:785-273-4770
Mailing Address - Fax:785-273-4793
Practice Address - Street 1:1271 SW WOODHULL ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1635
Practice Address - Country:US
Practice Address - Phone:785-273-4770
Practice Address - Fax:785-273-4793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty