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General NPI Number Information
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NPI Number | 1083753917
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Entity Type | Organization
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Legal Business Name | ESTEL L. LANDRETH, P.A.
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 4620 E DOUGLAS AVE
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City | WICHITA
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State | KS
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Zip | 67208-3930
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Country | US
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Telephone | 316-685-9276
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Fax | 316-685-2973
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Provider Business Mailing Address
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Address Line | 4620 E DOUGLAS AVE
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City | WICHITA
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State | KS
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Zip | 67208-3930
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Country | US
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Telephone | 316-685-9276
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Fax | 316-685-2973
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Authorized Official
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Title or Position | DENTIST
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Name | ESTEL LEE LANDRETH
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Credential | DDS
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Telephone | 316-685-9276
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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 |
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License Number State |
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