NPIMap

Organization Active NPI

Free State Dental

  • Dental Clinic/Center
  • De Soto, KS
National Provider Identifier
1912778804
Registry record updated Jan 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
FREE STATE DENTAL
Practice address
33391 Lexington Avenue
Suite C
De Soto, KS 66018
Phone
(785) 843-2636
NPI assigned
Jan 10, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2024

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

Authorized official

Name
Bradley Aaron Adams, DDSNPI 1942683313
Title
Partner
Phone
(785) 843-2636

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

33391 Lexington Avenue
Suite C
De Soto, KS 66018

Mailing address

4111 W 6TH St
Lawrence, KS 66049-4609
Phone (785) 843-2636

Other names 1

  • Free State Dental of De Soto Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Free State Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1704844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704844800000",
    "number": "1912778804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4111 W 6TH ST",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660494609",
            "telephone_number": "785-843-2636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33391 LEXINGTON AVENUE",
            "address_2": "SUITE C",
            "city": "DE SOTO",
            "state": "KS",
            "postal_code": "66018",
            "telephone_number": "785-843-2636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREE STATE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-10",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-08",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "AARON",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "785-843-2636",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Free State Dental of De Soto",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in De Soto, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2024; 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.