Healthcare Provider Details

I. General information

NPI: 1891819470
Provider Name (Legal Business Name): FINE ART OF FAMILY DENTISTRY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 E IRON AVE
SALINA KS
67401-3237
US

IV. Provider business mailing address

1615 E IRON AVE
SALINA KS
67401-3237
US

V. Phone/Fax

Practice location:
  • Phone: 785-823-5568
  • Fax: 785-823-0477
Mailing address:
  • Phone: 785-823-5568
  • Fax: 785-823-0477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6784
License Number StateKS

VIII. Authorized Official

Name: DR. LYNN R WUTHNOW
Title or Position: PRESIDENT
Credential: DDS
Phone: 785-823-5568