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.
Organization
COUNTRY CLUB DENTAL PA
Active
Organization
COUNTRY CLUB DENTAL PA
Active
Other names
Adventure Dental and Vision
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUN URBANOZO (CREDENTIALING MANAGER)
(719) 323-2362
Entity
Organization
Contact information
Practice address
400 SW 29TH ST, SUITE M, TOPEKA, KS 66611-1164
(785) 783-5981
(785) 783-5982
Mailing address
2221 E BIJOU ST, STE 100, COLORADO SPRINGS, CO 80909-8009
(719) 576-1850
(719) 955-3470
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
KS
1223G0001X
General Practice Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201199030A
—
KS
Enumeration date
03/23/2016
Last updated
09/09/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign upProduct
Developers