1457522575 NPI number — ENCHANTED SMILES, ESTHETIC AND GENERAL DENTISTRY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457522575 NPI number — ENCHANTED SMILES, ESTHETIC AND GENERAL DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENCHANTED SMILES, ESTHETIC AND GENERAL DENTISTRY
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:
Provider Other Organization Name Type Code:
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:
1457522575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2949 SW WANAMAKER DR
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66614-5325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-246-6300
Provider Business Mailing Address Fax Number:
785-246-6302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2949 SW WANAMAKER DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66614-5325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-246-6300
Provider Business Practice Location Address Fax Number:
785-246-6302
Provider Enumeration Date:
03/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CARACIONI
Authorized Official First Name:
STEFANIA
Authorized Official Middle Name:
ADRIANA
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
785-817-1639

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  60302 , 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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