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Contact Information

PRAIRIE VISTA DENTAL, LLC
209 W CENTRAL AVE
ULYSSES, KS67880
 Phone: 620-424-4311
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for PRAIRIE VISTA DENTAL, LLC

NPI Number 1255648036
LBN Legal business name PRAIRIE VISTA DENTAL, LLC
Authorized official BRET HOLMAN - (DENTIST/OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 09/01/2010
Last updated 11/30/2011 - About 15 years ago
Identifiers
KS License # 60655
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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