Healthcare Provider Details

I. General information

NPI: 1245328236
Provider Name (Legal Business Name): KANSAS PERIODONTICS & DENTAL IMPLANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2981 N. WEBB RD.
WICHITA KS
67226
US

IV. Provider business mailing address

2981 N. WEBB RD.
WICHITA KS
67226
US

V. Phone/Fax

Practice location:
  • Phone: 316-685-2731
  • Fax: 316-685-6946
Mailing address:
  • Phone: 316-685-2731
  • Fax: 316-685-6946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE MARKS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 316-685-2731