Healthcare Provider Details

I. General information

NPI: 1376320523
Provider Name (Legal Business Name): WYCLIFF FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 W 103RD ST STE 21
OVERLAND PARK KS
66214-2664
US

IV. Provider business mailing address

10400 W 103RD ST STE 21
OVERLAND PARK KS
66214-2664
US

V. Phone/Fax

Practice location:
  • Phone: 913-722-0610
  • Fax: 913-722-2893
Mailing address:
  • Phone: 913-722-0610
  • Fax: 913-722-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANNE A LANE
Title or Position: OWNER
Credential: DDS
Phone: 913-722-0610