Organization
DOUGLAS COUNTY DENTAL CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JULIE MEREDITH BRANSTROM (EXECUTIVE DIRECTOR)
(785) 312-7770
Entity
Organization
Contact information
Practice address
2210 YALE RD, LAWRENCE, KS 66049-2647
(785) 312-7770
(785) 312-9447
Mailing address
2210 YALE RD, LAWRENCE, KS 66049-2647
(785) 312-7770
(785) 312-9447
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
60218
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100414900A
—
KS
05
—
103395
—
KS
Enumeration date
10/18/2005
Last updated
11/05/2014
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