Organization
CUSTOM DENTAL OF OTTAWA, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENE RODGERS (COO)
(405) 227-6100
Entity
Organization
Contact information
Practice address
2030 S PRINCETON ST, OTTAWA, KS 66067
(785) 521-3737
Mailing address
2030 S PRINCETON ST, OTTAWA, KS 66067
(785) 521-3737
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/24/2019
Last updated
09/08/2021
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