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General NPI Number Information
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NPI Number | 1053734178
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Entity Type | Organization
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Legal Business Name | SYMMETRIS P.A.
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Dates
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Enumeration Date | 01/24/2014
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Last Update Date | 01/24/2014
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Provider Practice Location Address
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Address Line | 7730 E 37TH ST N
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City | WICHITA
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State | KS
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Zip | 67226-2822
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Country | US
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Telephone | 316-491-8200
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Fax | 316-491-8288
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Provider Business Mailing Address
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Address Line | 7730 E 37TH ST N
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City | WICHITA
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State | KS
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Zip | 67226-2822
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARISSA M GILL
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Credential | DDS
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Telephone | 316-491-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 60042
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License Number State | KS
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