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General NPI Number Information
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NPI Number | 1013019207
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Entity Type | Individual
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Provider Name | MARK ALAN HUENERGARDT D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1301 N WEST ST
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City | WICHITA
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State | KS
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Zip | 67203-1347
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Country | US
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Telephone | 316-942-2468
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Fax | 316-942-8387
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Provider Business Mailing Address
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Address Line | 1301 N WEST ST
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City | WICHITA
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State | KS
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Zip | 67203-1347
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Country | US
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Telephone | 316-942-2468
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Fax | 316-942-8387
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5848
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License Number State | KS
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