# DENTRUST KANSAS, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053000216
- **Authorized official:** AMANDA A CLARK (DIRECTOR OF CREDENTIALING)
- **Authorized official phone:** (267) 362-5938

## Contact information

- **Practice address:** 300 KANSAS AVE BLDG 700, FORT LEAVENWORTH, KS 66027-1139
- **Practice address phone:** (267) 927-5000
- **Mailing address:** 6097 EASTON RD, PIPERSVILLE, PA 18947-1810
- **Mailing address phone:** (267) 362-5938

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 05/03/2023
- **Last updated:** 05/03/2023