Organization
PRAIRIE VISTA DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRET J HOLMAN D.D.S. (DENTIST/OWNER)
(620) 424-4311
Entity
Organization
Contact information
Practice address
209 W CENTRAL AVE, UYSSES, KS 67880
(620) 424-4311
Mailing address
209 W CENTRAL AVE, ULYSSES, KS 67880-2403
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
60655
KS
Other
Enumeration date
09/01/2010
Last updated
11/30/2011
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