Basic Information
Provider Information
NPI: 1447325212
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BANDY
FirstName: RUFUS
MiddleName: YOUNG
NamePrefix: DR.
NameSuffix: III
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3005 CHERRY HILL
Address2:  
City: MANHATTAN
State: KS
PostalCode: 66503
CountryCode: US
TelephoneNumber: 7852394427
FaxNumber: 7852397245
Practice Location
Address1: 600 CAISSON HILL ROAD
Address2:  
City: FT. RILEY
State: KS
PostalCode: 664425043
CountryCode: US
TelephoneNumber: 7852397241
FaxNumber: 7852397245
Other Information
ProviderEnumerationDate: 11/21/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223E0200X60247KSY Dental ProvidersDentistEndodontics

No ID Information.


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