Healthcare Provider Details

I. General information

NPI: 1972005262
Provider Name (Legal Business Name): KRISTAL DEANN RAYA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2143 N COLLECTIVE LN
WICHITA KS
67206-3504
US

IV. Provider business mailing address

2143 N COLLECTIVE LN
WICHITA KS
67206-3504
US

V. Phone/Fax

Practice location:
  • Phone: 316-681-3228
  • Fax:
Mailing address:
  • Phone: 316-681-3228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number62097
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: