Organization
STTT DENTAL SERVICES LLC CORP
Active
Other names
Chautauqua Hills Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. COLIN MICHAEL SHAWHAN D.D.S. (DENTIST)
(620) 725-3122
Entity
Organization
Contact information
Practice address
120 W OSAGE ST, SEDAN, KS 67361-1518
(620) 725-3122
(620) 725-5395
Mailing address
120 W OSAGE ST, SEDAN, KS 67361-1518
(620) 725-3122
(620) 725-5395
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
305S00000X
Point of Service
61288
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201126710A
—
KS
Enumeration date
05/02/2016
Last updated
11/07/2019
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