# MAPLE DENTAL, LLC

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

## Provider details

- **NPI number:** 1275960932
- **Authorized official:** DR. THEODORE J MAPLE DDS (DENTIST)
- **Authorized official phone:** (620) 356-1221

## Contact information

- **Practice address:** 307 N MAIN ST, ULYSSES, KS 67880-2132
- **Practice address phone:** (620) 356-1221
- **Practice address fax:** (620) 356-5204
- **Mailing address:** 307 N MAIN ST, ULYSSES, KS 67880-2132
- **Mailing address phone:** (620) 356-1221
- **Mailing address fax:** (620) 356-5204

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4614 | KS | Yes |

## Other

- **Enumeration date:** 09/26/2013
- **Last updated:** 09/26/2013