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General NPI Number Information
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NPI Number | 1255526091
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL ENDODONTICS
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 09/13/2007
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Provider Practice Location Address
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Address Line | 7570 W 21ST ST N STE 1042B
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City | WICHITA
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State | KS
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Zip | 67205-1763
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Country | US
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Telephone | 316-729-5670
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Fax | 316-729-5496
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Provider Business Mailing Address
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Address Line | 7570 W 21ST ST N STE 1042B
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City | WICHITA
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State | KS
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Zip | 67205-1763
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Country | US
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Telephone | 316-729-5670
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Fax | 316-729-5496
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MRS. MONICA TURNER TURNER
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Credential |
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Telephone | 316-729-5670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 60147
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License Number State | KS
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