Provider Demographics
NPI:1942744107
Name:AD ASTRA FAMILY DENTISTRY, L.L.C.
Entity Type:Organization
Organization Name:AD ASTRA FAMILY DENTISTRY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-220-6346
Mailing Address - Street 1:5963 SW 31ST TER
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4123
Mailing Address - Country:US
Mailing Address - Phone:785-286-7541
Mailing Address - Fax:785-783-2962
Practice Address - Street 1:1271 SW WOODHULL ST STE A
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1849
Practice Address - Country:US
Practice Address - Phone:785-286-7541
Practice Address - Fax:785-783-2962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60471122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty