Dentrust Kansas, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DENTRUST KANSAS, PA

Practice address

300 Kansas Ave BLDG 700
Fort Leavenworth, KS 66027-1139

Phone

(267) 927-5000

NPI assigned

May 3, 2023

Last updated

May 3, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amanda A Clark

Title

Director of Credentialing

Phone

(267) 362-5938

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683072000000",
    "number": "1053000216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6097 EASTON RD",
            "city": "PIPERSVILLE",
            "state": "PA",
            "postal_code": "189471810",
            "telephone_number": "267-362-5938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 KANSAS AVE BLDG 700",
            "city": "FORT LEAVENWORTH",
            "state": "KS",
            "postal_code": "660271139",
            "telephone_number": "267-927-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTRUST KANSAS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-03",
        "last_updated": "2023-05-03",
        "certification_date": "2023-05-03",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "267-362-5938"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trista Dashner, LCSW
• Anh Hinshaw Davis, M.D.
• Melanie Ann Davison, PHARM. D
• Enrique De la Guardia, M.D.
• Ernest Francia Degenhardt, NURSE PRACTITIONER
• Anise Gabrielle Derosin
• Celia Dial, R.N.
• Cory Austin Diaz, DDS
• Alexandra Nicole Dibasilio
• Jennifer Dick, RN

• General Practice Dentistry in Fort Leavenworth, KS
• Providers in Fort Leavenworth, KS by specialty
• General Practice Dentistry in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.