Provider Demographics
NPI:1285827014
Name:ADVANCED DENTAL P.A.
Entity type:Organization
Organization Name:ADVANCED DENTAL P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:IRWIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:BOE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:913-557-3333
Mailing Address - Street 1:21 W WEA ST
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-1462
Mailing Address - Country:US
Mailing Address - Phone:913-557-3333
Mailing Address - Fax:913-557-9191
Practice Address - Street 1:21 W WEA ST
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1462
Practice Address - Country:US
Practice Address - Phone:913-557-3333
Practice Address - Fax:913-557-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS603031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty