1194061804 NPI number — NEW HORIZONS DENTAL CARE

Table of content: (NPI 1194061804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194061804 NPI number — NEW HORIZONS DENTAL CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW HORIZONS DENTAL CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEW HORIZONS DENTAL CARE OF LENEXA
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194061804
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1920 S OHIO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALINA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67401-6643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-825-7197
Provider Business Mailing Address Fax Number:
785-827-9400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19613 W 101ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENEXA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66220-8600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-390-5110
Provider Business Practice Location Address Fax Number:
913-390-5664
Provider Enumeration Date:
12/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GROSS
Authorized Official First Name:
GUY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
ONWER
Authorized Official Telephone Number:
785-825-7197

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  60323 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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