Healthcare Provider Details

I. General information

NPI: 1619957206
Provider Name (Legal Business Name): TWIETMEYER DENTISTRY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 N MAIN
CHENEY KS
67025
US

IV. Provider business mailing address

107 N MAIN
CHENEY KS
67025
US

V. Phone/Fax

Practice location:
  • Phone: 316-540-3171
  • Fax: 316-542-9861
Mailing address:
  • Phone: 316-540-3171
  • Fax: 316-542-9861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5739
License Number StateKS

VIII. Authorized Official

Name: STEVEN F TWIETMEYER
Title or Position: PRESIDENT/OWNER
Credential: DDS
Phone: 316-540-3171