Provider Demographics
NPI:1457698599
Name:BETTIN, STANLEY LEON (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:LEON
Last Name:BETTIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 696
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:KS
Mailing Address - Zip Code:67554-0696
Mailing Address - Country:US
Mailing Address - Phone:620-257-5193
Mailing Address - Fax:620-257-5194
Practice Address - Street 1:220 W COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:KS
Practice Address - Zip Code:67554-2716
Practice Address - Country:US
Practice Address - Phone:620-257-5193
Practice Address - Fax:620-257-5194
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS43871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS8289OtherBCBSKS
KS1000959610AMedicaid