# PRAIRIE DENTAL ASSOCIATES

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

## Provider details

- **NPI number:** 1174533210
- **Authorized official:** DR. DEE JO HOLMAN DDS (DENTIST OWNER SEC-TREASURER)
- **Authorized official phone:** (620) 792-1941

## Contact information

- **Practice address:** 1701 WILLIAMS, GREAT BEND, KS 67530-2542
- **Practice address phone:** (620) 792-1941
- **Practice address fax:** (620) 792-2766
- **Mailing address:** 1701 WILLIAMS, GREAT BEND, KS 67530-2542
- **Mailing address phone:** (620) 792-1941
- **Mailing address fax:** (620) 792-2766

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 5951 | KS | Yes |

## Other

- **Enumeration date:** 08/09/2006
- **Last updated:** 08/22/2020