Country Club Dental PA

NPI #1699137109 in Topeka, Kansas

Provider Information

NPI Number: 1699137109
Entity Type: Organization
Organization Name: Country Club Dental PA
Primary Specialty: Dentist - General Practice
Enumeration Date: Mar 23, 2016
Last Updated: Sep 9, 2025

Practice Location

Address: 400 SW 29TH ST
Address 2: SUITE M
City: Topeka
State: Kansas
ZIP Code: 66611-1164
Phone: (785) 783-5981

Authorized Official

Name: SHAUN URBANOZO
Title: CREDENTIALING MANAGER
Phone: (719) 323-2362

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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