Healthcare Provider Details

I. General information

NPI: 1376005124
Provider Name (Legal Business Name): CAMBRIDGE FAMILY DENTISTRY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 N WEBB RD STE 301
WICHITA KS
67206-3410
US

IV. Provider business mailing address

2020 N WEBB RD STE 301
WICHITA KS
67206-3410
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 Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDY M GRIMM
Title or Position: OFFICE MANAGER
Credential:
Phone: 316-687-2110