Organization
FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH ELWYN BEAN D.D.S. (OWNER/ DENTIST)
(620) 424-4499
Entity
Organization
Contact information
Practice address
113 S MAIN ST, SUITE A, ULYSSES, KS 67880-2519
(620) 424-4499
(620) 424-4498
Mailing address
113 S MAIN ST, SUITE A, ULYSSES, KS 67880-2519
(620) 424-4499
(620) 424-4498
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
5513
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100225900A
—
KS
Enumeration date
04/12/2012
Last updated
04/12/2012
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