Healthcare Provider Details

I. General information

NPI: 1891965224
Provider Name (Legal Business Name): JONAS LICHTY DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 N WEBB RD
WICHITA KS
67206-3405
US

IV. Provider business mailing address

1919 N WEBB RD
WICHITA KS
67206-3405
US

V. Phone/Fax

Practice location:
  • Phone: 316-634-1414
  • Fax: 316-634-2907
Mailing address:
  • Phone: 316-634-1414
  • Fax: 316-634-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number60782
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: