Custom Dental of Ottawa, PA

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

CUSTOM DENTAL OF OTTAWA, PA

Practice address

2030 S Princeton St
Ottawa, KS 66067

Phone

(785) 521-3737

NPI assigned

Jul 24, 2019

Organization subpart

No

Name

Rene Rodgers

Title

Coo

Phone

(405) 227-6100

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 8, 2021.

{
    "created_epoch": "1563926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631059200000",
    "number": "1508419938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2030 S PRINCETON ST",
            "city": "OTTAWA",
            "state": "KS",
            "postal_code": "66067",
            "telephone_number": "785-521-3737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2030 S PRINCETON ST",
            "city": "OTTAWA",
            "state": "KS",
            "postal_code": "66067",
            "telephone_number": "785-521-3737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM DENTAL OF OTTAWA, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-24",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "status": "A",
        "authorized_official_last_name": "RODGERS",
        "authorized_official_first_name": "RENE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "405-227-6100"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hilary Ayers Crist, M.S., ED., SLP
• Jacqueline G Cunningham, APRN
• Sara Rene Cunningham, ARNP
• Debra Curn, PHARMD
• Charity Curtis, LCP
• Dale D Dalenberg, M.D.
• Joshua Dallman, MS, LAT, ATC
• Julie E Dandreo, CCC-SLP
• Kinsy Joe Debolt, APRN
• Holly Dickinson, PT

• All providers in Ottawa, KS
• Dental Clinic/Center in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2021; 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.