NPI: 1497269963 · HIAWATHA, KS 66434 · General Practice Dentistry · NPI assigned 11/20/2017
| Authorized Official | HAEDT, JORDAN (DENTIST OWNER) |
| NPI Enumeration Date | 11/20/2017 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 13 | $330.00 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | Prophylaxis - child | 13 | 13 | $330.00 |