| Main Street Dental, Llc | |
|
603 S Main St Pratt KS 67124-2630 | |
| (620) 672-9922 | |
| (620) 672-9966 |
| Full Name | Main Street Dental, Llc |
|---|---|
| Speciality | Dentist |
| Location | 603 S Main St, Pratt, Kansas |
| Authorized Official Name and Position | John D. Mathes (OWNER) |
| Authorized Official Contact | 6206729922 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Dental, Llc 603 S Main St Pratt KS 67124-2630 Ph: (620) 672-9922 | Main Street Dental, Llc 603 S Main St Pratt KS 67124-2630 Ph: (620) 672-9922 |
| NPI Number | 1154570448 |
|---|---|
| Provider Enumeration Date | 09/11/2008 |
| Last Update Date | 02/10/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154570448 | NPI | - | NPPES |
| 116863 | Other | KS | BLUE CROSS & BLUE SHEILD |
| 100222640A | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 5971 (Kansas) | Primary |
| 122300000X | Dentist | 60593 (Kansas) | Secondary |
L Ronald Ingram Dds Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 105 W 4th, Pratt, KS 67124 Phone: 620-672-3612 Fax: 620-672-3612 | |
Pratt Family Dental, P.a. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 105 W 4th St, Pratt, KS 67124 Phone: 620-672-3612 Fax: 620-672-3314 | |
Cottonwood Dental Pratt, P.a. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 603 S Main St, Pratt, KS 67124 Phone: 620-672-9922 |