Basic Information
Provider Information
NPI: 1437115516
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OSWALD
FirstName: JEFFREY
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.D.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2200 SW GAGE BLVD
Address2: DENTAL SERVICES
City: TOPEKA
State: KS
PostalCode: 666220001
CountryCode: US
TelephoneNumber: 7853503111
FaxNumber: 7853504457
Practice Location
Address1: 2200 SW GAGE BLVD
Address2: DENTAL SERVICES
City: TOPEKA
State: KS
PostalCode: 666220001
CountryCode: US
TelephoneNumber: 7853503111
FaxNumber: 7853504457
Other Information
ProviderEnumerationDate: 04/26/2006
LastUpdateDate: 07/11/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X60012KSY Dental ProvidersDentistGeneral Practice

No ID Information.


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