Organization
BLUE SKIES DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRAVIS RAY WYMER DDS (OWNER)
(785) 392-0770
Entity
Organization
Contact information
Practice address
4201 ANDERSON AVE, STE A, MANHATTAN, KS 66503-7601
(785) 537-4337
Mailing address
3863 HAYOVEL PL, MANHATTAN, KS 66503-8529
(785) 392-0770
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
12/02/2022
Last updated
04/27/2023
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