Provider Demographics
NPI:1457920548
Name:SABETHA DENTAL LLC
Entity Type:Organization
Organization Name:SABETHA DENTAL LLC
Other - Org Name:BETSY TEDMAN DMD LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:TEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:785-284-2323
Mailing Address - Street 1:1309 S US OLD HIGHWAY 75
Mailing Address - Street 2:
Mailing Address - City:SABETHA
Mailing Address - State:KS
Mailing Address - Zip Code:66534
Mailing Address - Country:US
Mailing Address - Phone:785-284-2323
Mailing Address - Fax:785-284-0075
Practice Address - Street 1:1309 S US OLD HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:SABETHA
Practice Address - State:KS
Practice Address - Zip Code:66534
Practice Address - Country:US
Practice Address - Phone:785-284-2323
Practice Address - Fax:785-284-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1316932320Medicaid