COUNTRY CLUB DENTAL PA (NPI# 1699137109) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699137109 |
| Entity Type | Organization |
| Organization Name | COUNTRY CLUB DENTAL PA |
| Other Organization Name | ADVENTURE DENTAL AND VISION |
| Practice Address |
400 Sw 29th St Suite M Topeka KS 66611-1164 |
| Mailing Address |
2221 E Bijou St Ste 100 Colorado Springs CO 80909-8009 |
| Practice Telephone | 7857835981 |
| Practice Fax Number | 7857835982 |
| Mailing Telephone | 7195761850 |
| Mailing Fax Number | 7199553470 |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2019-10-22 |
| Authorized Official Name | SHAUN URBANOZO (CREDENTIALING MANAGER) |
| Authorized Official Telephone | 7193232362 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers | ||
| Y | 1223G0001X |
Dentist Specialization: General Practice |
KS | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KS | 201199030A | 05 |
| Other Name | Type Code |
|---|---|
| Adventure Dental and Vision | Doing Business As Name - Organization |
| Street Address |
400 SW 29TH ST SUITE M |
| City | TOPEKA |
| State | KS |
| Zip Code | 66611-1164 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407041742 | Vanessa A Parris | Dentist | 400 Sw 29th St, Topeka, KS 66611-1164 | 2007-09-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144870619 | Diane Delois Taylor | Technician | 3619 Sw Kirklawn Ave, Topeka, KS 66611 | 2019-09-17 |
| 1891189155 | Day-by-day Staff Relief, LLC | Home Health | 2016 Sw 37th St, Suite 100, Topeka, KS 66611 | 2015-03-25 |
| 1740606417 | Kerry Mees | Speech-Language Pathologist | 1205 Sw 29th St., Topeka, KS 66611 | 2014-03-05 |
| 1497052005 | Angela Diane Mcclain | Counselor | 1601 S.w 37th Street, Topeka, KS 66611 | 2011-02-16 |
| 1114230349 | Heather M Prichard | Social Worker | 2906 Sw Medford Ave, Topeka, KS 66611 | 2010-07-16 |
| 1740353101 | Jan C Hendrix Lcpc Lscsw Pa | Social Worker | 2300 Sw 29th Street Suite 222, Topeka, KS 66611 | 2006-11-15 |
| 1366538886 | Charles G Beier | Optometrist | 2400 S.w. 29th St., #136, Topeka, KS 66611 | 2006-10-04 |
| 1427140045 | Renee D Rodgers | Social Worker | 2201 Sw 29th, Topeka, KS 66611 | 2006-09-29 |
| 1295708063 | Colleen Ellis | Social Worker | 2201 Sw 29th St, Topeka, KS 66611 | 2006-02-10 |
| 1053310458 | Dennis D Tietze | Family Medicine | 1101 Sw 29th Street, Topeka, KS 66611 | 2005-07-18 |
| Find all providers in zip 66611 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740772722 | Nathan A Ideus | Dentist | 1835 Nw Topeka Blvd Ste 111, Topeka, KS 66608-1892 | 2018-06-05 |
| 1457767105 | Eugene Curtis | Dentist | 2221 Sw Auburn Rd, Topeka, KS 66614 | 2014-07-02 |
| 1417372921 | Bhavna Kapoor | Dentist | 400 Sw 29th Street, Topeka, KS 66611-1164 | 2014-02-20 |
| 1932358488 | Rutherford-peterson Dentistry LLC | Dentist | 3316 Se 28th Terrace, Topeka, KS 66605 | 2008-09-09 |
| 1831308105 | Brenda Jane Gloor Pruitt | Dentist | 214 S. Main St., Topeka, IN 46571 | 2007-05-22 |
| 1881722049 | Jeffrey B Clark | Dentist | 5990 Sw 28th St, Suite D, Topeka, KS 66614-3525 | 2007-03-01 |
| 1467540369 | Robert L. Bell | Dentist | 2930 Sw Wanamaker Dr Ste 7, Topeka, KS 66614-4116 | 2006-10-10 |
| 1891881389 | James G Pratt | Dentist | 5605 Sw Barrington Ct S, Suite 200, Topeka, KS 66614 | 2006-10-04 |
| 1588765572 | Robert E. Lacy | Dentist | 4301 Sw Huntoon St Ste 8, Topeka, KS 66604-1967 | 2006-09-25 |
| 1124132915 | Russell A Forrest Jr. | Dentist | 2300 Sw 29th St, Suite 221, Topeka, KS 66611-1739 | 2006-08-18 |
| Find all providers in TOPEKA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.