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Organization
STTT DENTAL SERVICES LLC CORP
Active
Organization
STTT DENTAL SERVICES LLC CORP
Active
Other names
Chautauqua Hills Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. COLIN MICHAEL SHAWHAN D.D.S. (DENTIST)
(620) 725-3122
Entity
Organization
Contact information
Practice address
120 W OSAGE ST, SEDAN, KS 67361-1518
(620) 725-3122
(620) 725-5395
Mailing address
120 W OSAGE ST, SEDAN, KS 67361-1518
(620) 725-3122
(620) 725-5395
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
305S00000X
Point of Service
61288
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201126710A
—
KS
Enumeration date
05/02/2016
Last updated
11/07/2019
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