Douglas County Dental Clinic, Inc

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

License

60218 Issued in KS

Legal business name

DOUGLAS COUNTY DENTAL CLINIC, INC

Practice address

2210 Yale Rd
Lawrence, KS 66049-2647

Phone

(785) 312-7770

Fax

(785) 312-9447

NPI assigned

Oct 18, 2005

Last updated

Nov 5, 2014By 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

Ms. Julie Meredith Branstrom

Title

Executive Director

Phone

(785) 312-7770

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415145600000",
    "number": "1396734737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2210 YALE RD",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660492647",
            "telephone_number": "785-312-7770",
            "fax_number": "785-312-9447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2210 YALE RD",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660492647",
            "telephone_number": "785-312-7770",
            "fax_number": "785-312-9447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLAS COUNTY DENTAL CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-18",
        "last_updated": "2014-11-05",
        "status": "A",
        "authorized_official_last_name": "BRANSTROM",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "MEREDITH",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "785-312-7770",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": "KS",
            "license": "60218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103395",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100414900A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marissa Brianne Dorsey
• Angela Dossett, APRN
• Traci Denise Dotson
• Annelise C Doty, OTR/L
• Douglas County Child Development Association
• Douglas County Infant Toddler Coordinating Counsil
• Douglas County Senior Services, Inc.
• Douglas County Visiting Nurses Association, Inc.
• Douglas County Visiting Nurses Association, Inc.
• Douglas County Visiting Nurses Association, Inc.

• Public Health Dentistry in Lawrence, KS
• Providers in Lawrence, KS by specialty
• Public Health Dentistry in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2014; 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.