# CEDAR LODGE DENTAL CENTER

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

## Provider details

- **NPI number:** 1487751509
- **Authorized official:** DR. DAVID L BERRY D.D.S. (PRESIDENT)
- **Authorized official phone:** (785) 625-7369

## Contact information

- **Practice address:** 1001 CODY AVE, HAYS, KS 67601-2430
- **Practice address phone:** (785) 625-7369
- **Practice address fax:** (785) 625-7667
- **Mailing address:** 1001 CODY AVE, HAYS, KS 67601-2430
- **Mailing address phone:** (785) 625-7369
- **Mailing address fax:** (785) 625-7667

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 5950 | KS | Yes |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 59703 | BCBS KS INSURANCE | KS |
| 01 | — | 835408 | UNITED CONCORDIA DENTAL | PA |