Healthcare Provider Details

I. General information

NPI: 1992176531
Provider Name (Legal Business Name): GREAT PLAINS DENTAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N CARRIAGE PKWY #60
WICHITA KS
67208
US

IV. Provider business mailing address

650 N CARRIAGE PKWY #60
WICHITA KS
67208-4507
US

V. Phone/Fax

Practice location:
  • Phone: 316-686-2721
  • Fax: 316-395-1233
Mailing address:
  • Phone: 316-686-2721
  • Fax: 316-395-1233

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: DALE MAYFIELD
Title or Position: PRESIDENT
Credential:
Phone: 770-916-5036