Organization
FIRST AVENUE DENTAL, P.A.
Active
Other names
First Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESICKA J WILKINSON (ADMINISTRATION)
(620) 225-5154
Entity
Organization
Contact information
Practice address
2306 1ST AVE, DODGE CITY, KS 67801-2527
(620) 371-6630
(620) 371-6631
Mailing address
2306 1ST AVE, DODGE CITY, KS 67801-2527
(620) 225-5154
(620) 371-8870
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200867320A
—
KS
05
—
201223110A
—
KS
Enumeration date
06/27/2011
Last updated
08/19/2021
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