Provider Demographics
NPI:1780224121
Name:FLINTHILLSDENTALPA
Entity type:Organization
Organization Name:FLINTHILLSDENTALPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANCELADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-321-3455
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:KS
Mailing Address - Zip Code:66536-0129
Mailing Address - Country:US
Mailing Address - Phone:785-321-3455
Mailing Address - Fax:785-321-3466
Practice Address - Street 1:104 S. DE SMET LN.
Practice Address - Street 2:STE. 6
Practice Address - City:ST MARYS
Practice Address - State:KS
Practice Address - Zip Code:66536
Practice Address - Country:US
Practice Address - Phone:785-321-3455
Practice Address - Fax:785-321-3466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty