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General NPI Number Information
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NPI Number | 1235898214
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Entity Type | Organization
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Legal Business Name | GHANTA DENTISTRY PA
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Dates
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Enumeration Date | 12/16/2021
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Last Update Date | 12/16/2021
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Provider Practice Location Address
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Address Line | 415 S 119TH ST W
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City | WICHITA
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State | KS
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Zip | 67235-1816
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Country | US
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Telephone | 316-941-5997
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Fax |
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Provider Business Mailing Address
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Address Line | 415 S 119TH ST W
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City | WICHITA
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State | KS
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Zip | 67235-1816
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Country | US
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Telephone | 316-941-5997
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. RANJIT GHANTA
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Credential | DMD
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Telephone | 432-934-1548
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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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