Healthcare Provider Details

I. General information

NPI: 1558949784
Provider Name (Legal Business Name): WICHITA ENDODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 08/04/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7721 W 21ST ST
WITCHITA KS
67205-1737
US

IV. Provider business mailing address

12219 E CENTRAL AVE
WICHITA KS
67206-2808
US

V. Phone/Fax

Practice location:
  • Phone: 316-681-1099
  • Fax: 316-661-2417
Mailing address:
  • Phone: 316-681-1099
  • Fax: 316-661-2417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. CRAIG FRANK HOFFMANN
Title or Position: OWNER/PROVIDER
Credential: DDS
Phone: 316-681-1099