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General NPI Number Information
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NPI Number | 1245370345
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Entity Type | Organization
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Legal Business Name | KIDSPACE PEDIATRIC DENTISTRY,P.A
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 430 N WOODLAWN ST STE 1
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City | WICHITA
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State | KS
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Zip | 67208-4334
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Country | US
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Telephone | 316-684-2100
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Fax | 316-684-2101
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Provider Business Mailing Address
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Address Line | 430 N WOODLAWN ST STE 1
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City | WICHITA
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State | KS
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Zip | 67208-4334
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Country | US
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Telephone | 316-684-2100
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Fax | 316-684-2101
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JULIE S. LE
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Credential |
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Telephone | 316-684-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 6522
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License Number State | KS
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