Healthcare Provider Details

I. General information

NPI: 1184773541
Provider Name (Legal Business Name): CAMBRIDGE FAMILY DENTISTY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 N WEBB RD BLDG 301
WICHITA KS
67206
US

IV. Provider business mailing address

2020 N WEBB RD BLDG 301
WICHITA KS
67206
US

V. Phone/Fax

Practice location:
  • Phone: 316-687-2110
  • Fax: 316-636-9539
Mailing address:
  • Phone: 316-687-2110
  • Fax: 316-636-9539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MARVIN DEAN WRIGHT
Title or Position: PRESIDENT
Credential: DDS
Phone: 316-687-2110