Organization
COUNTRYSIDE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. REXANNA JO KNAPP (OFFICE MANAGER)
(620) 232-2273
Entity
Organization
Contact information
Practice address
1034 NORTH HIGHWAY 69, FRONTENAC, KS 66763
(620) 232-2273
(620) 232-9308
Mailing address
PO BOX 973, FRONTENAC, KS 66763
(620) 232-2273
(620) 232-9308
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
60140
KS
122300000X
Dentist
60336
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30137
DELTA
KS
Enumeration date
12/12/2006
Last updated
08/22/2020
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