Healthcare Provider Details

I. General information

NPI: 1114266293
Provider Name (Legal Business Name): SYMMETRIS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E. LINCOLN
WELLINGTON KS
67152
US

IV. Provider business mailing address

122 E. LINCOLN
WELLINGTON KS
67152
US

V. Phone/Fax

Practice location:
  • Phone: 620-326-5751
  • Fax: 620-326-7915
Mailing address:
  • Phone: 620-326-5751
  • Fax: 620-326-7915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60042
License Number StateKS

VIII. Authorized Official

Name: CARISSA M GILL
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 620-326-5751