| Douglas County Dental Clinic, Inc | |
|
2210 Yale Rd Lawrence KS 66049-2647 | |
| (785) 312-7770 | |
| (785) 312-9447 |
| Full Name | Douglas County Dental Clinic, Inc |
|---|---|
| Speciality | Dentist - Dental Public Health |
| Location | 2210 Yale Rd, Lawrence, Kansas |
| Authorized Official Name and Position | Julie Meredith Branstrom (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7853127770 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Douglas County Dental Clinic, Inc 2210 Yale Rd Lawrence KS 66049-2647 Ph: (785) 312-7770 | Douglas County Dental Clinic, Inc 2210 Yale Rd Lawrence KS 66049-2647 Ph: (785) 312-7770 |
| NPI Number | 1396734737 |
|---|---|
| Provider Enumeration Date | 10/18/2005 |
| Last Update Date | 11/05/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396734737 | NPI | - | NPPES |
| 103395 | Medicaid | KS | |
| 100414900A | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | 60218 (Kansas) | Primary |
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