# COUNTRYSIDE DENTISTRY

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1457411928
- **Authorized official:** MS. REXANNA JO KNAPP (OFFICE MANAGER)
- **Authorized official phone:** (620) 232-2273

## Contact information

- **Practice address:** 1034 NORTH HIGHWAY 69, FRONTENAC, KS 66763
- **Practice address phone:** (620) 232-2273
- **Practice address fax:** (620) 232-9308
- **Mailing address:** PO BOX 973, FRONTENAC, KS 66763
- **Mailing address phone:** (620) 232-2273
- **Mailing address fax:** (620) 232-9308

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 60140 | KS | Yes |
| 122300000X | Dentist | 60336 | KS | — |

## Other

- **Enumeration date:** 12/12/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 30137 | DELTA | KS |