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

Last updated

Sep 8, 2021By 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

Rene Rodgers

Title

Coo

Phone

(405) 227-6100

Specialties & licenses 1

Addresses

Locations

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

{
    "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

• Dental Clinic/Center in Ottawa, KS
• Providers in Ottawa, KS by specialty
• 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.