Healthcare Provider Details

I. General information

NPI: 1568521532
Provider Name (Legal Business Name): WYLIE LEON BELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 NORTH HIGHWAY 69
FRONTENAC KS
66763
US

IV. Provider business mailing address

PO BOX 973
FRONTENAC KS
66763
US

V. Phone/Fax

Practice location:
  • Phone: 620-232-2273
  • Fax: 620-232-9308
Mailing address:
  • Phone: 620-232-2273
  • Fax: 620-232-9308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60140
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: