# MICHAEL J DOSTAL DDS, LLC

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

## Provider details

- **NPI number:** 1164712485
- **Authorized official:** DR. MICHAEL DOSTAL DDS (SOLE MEMBER)
- **Authorized official phone:** (785) 550-2682

## Contact information

- **Practice address:** 5408 ROBERTS ST, SHAWNEE, KS 66226-3937
- **Practice address phone:** (785) 550-2682
- **Mailing address:** 5408 ROBERTS ST, SHAWNEE, KS 66226-3937

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 60656 | KS | Yes |

## Other

- **Enumeration date:** 04/08/2011
- **Last updated:** 04/08/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200698320A | — | KS |