CUSTOM DENTAL OF OTTAWA, PA (NPI# 1508419938) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508419938 |
| Entity Type | Organization |
| Organization Name | CUSTOM DENTAL OF OTTAWA, PA |
| Practice Address |
2030 S Princeton St Ottawa KS 66067 |
| Practice Telephone | 7855213737 |
| Mailing Telephone | 7855213737 |
| Enumeration Date | 2019-07-24 |
| Last Update Date | 2019-07-24 |
| Authorized Official Name | RENE RODGERS (COO) |
| Authorized Official Telephone | 4052276100 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| Street Address |
2030 S PRINCETON ST |
| City | OTTAWA |
| State | KS |
| Zip Code | 66067 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407482870 | Katie Jean Turpin | Occupational Therapist | 3901 S Main St, Ottawa, KS 66067 | 2020-03-18 |
| 1619526464 | Jennifer Raybern | Specialist/Technologist | 1001 S Cedar St, Ottawa, KS 66067 | 2019-09-04 |
| 1861948507 | Jeffrey Byrne Kelley | Pharmacist | 2101 S Princeton Rd, Ottawa, KS 66067 | 2016-09-01 |
| 1619185188 | Vintage Park At Ottawa LLC | Assisted Living Facility | 2250 S Elm St, Ottawa, KS 66067 | 2007-05-18 |
| 1356423495 | Ottawa Oral Surgery Lc | Dentist | 107 E 23rd St, Ste 3 Ottawa Oral Surgery Lc, Ottawa, KS 66067 | 2006-10-19 |
| 1669564332 | Sandra K Staneart | Nurse Practitioner | 1302 South Main St, Suite 1, Ottawa, KS 66067 | 2006-09-29 |
| 1467553214 | Nancy L Pauw | Social Worker | 2476 Reno Rd, Ottawa, KS 66067 | 2006-09-26 |
| 1700847043 | T.a. Rainbolt, Dds, P.a. | Dentist | 1334 S. Main Street, Ottawa, KS 66067 | 2006-03-28 |
| 1659341634 | Milton Laverne Sampson | Nurse Anesthetist, Certified Registered | 1301 S Main, Ottawa, KS 66067 | 2006-01-24 |
| 1447220405 | Curtis John Bittner | Nurse Anesthetist, Certified Registered | 1301 South Main, Ottawa, KS 66067 | 2006-01-24 |
| Find all providers in zip 66067 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235592049 | Ottawa Children's Dentistry, LLC | Clinic/Center | 1704 Polaris Cir, Ottawa, IL 61350-1773 | 2016-03-30 |
| 1598839946 | Richard A Ewald and William L Wrobel Dds Ltd | Clinic/Center | 1704 Polaris Cir, Ottawa, IL 61350-1773 | 2006-11-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669071783 | David L. Foley D.d.s. Inc | Clinic/Center | 940 N Andover Rd, Andover, KS 67002-9787 | 2020-10-20 |
| 1629680368 | Alexander J. Clark Dds, LLC | Clinic/Center | 8340 Mission Rd Ste 118, Prairie Village, KS 66206-1362 | 2020-08-22 |
| 1225653959 | Moxley Family Dental, LLC | Clinic/Center | 15455 E 13th St N, Wichita, KS 67230-7572 | 2020-06-09 |
| 1760018576 | Senior Dental Care of Ms, LLC | Clinic/Center | 8500 W 110th St Ste 450, Overland Park, KS 66210-4029 | 2020-03-13 |
| 1962037523 | Beverly Moon Dmd LLC | Clinic/Center | 4601 W 109th St Ste 240, Overland Park, KS 66211-1323 | 2020-03-04 |
| 1518504976 | M&m Family Dentistry LLC | Clinic/Center | 9319 E Harry St Ste 126, Wichita, KS 67207-5070 | 2019-12-04 |
| 1811542640 | Medical Heights Dental Center, Pa | Clinic/Center | 100 W Ross Blvd Ste 2c, Dodge City, KS 67801-7217 | 2019-08-08 |
| 1114588639 | Evolve Family Dentistry, LLC | Clinic/Center | 1133 College Ave Ste A103, Manhattan, KS 66502-2795 | 2019-06-25 |
| 1477112563 | Wamego Dental Professionals LLC | Clinic/Center | 1519 W Us Highway 24, Wamego, KS 66547-1322 | 2019-06-11 |
| 1235608902 | Luke Joliff, LLC | Clinic/Center | 11551 Granada St Ste 200, Leawood, KS 66211-1444 | 2018-11-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.