Provider Demographics
NPI:1912077116
Name:EMPORIA ORAL SURGERY LC
Entity Type:Organization
Organization Name:EMPORIA ORAL SURGERY LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:C
Authorized Official - Last Name:GAUS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-342-5930
Mailing Address - Street 1:2510 W 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-6102
Mailing Address - Country:US
Mailing Address - Phone:620-342-5930
Mailing Address - Fax:620-343-2972
Practice Address - Street 1:2510 W 15TH AVE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-6102
Practice Address - Country:US
Practice Address - Phone:620-342-5930
Practice Address - Fax:620-343-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS67061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS017273Medicare ID - Type Unspecified