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General NPI Number Information
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NPI Number | 1568981231
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Entity Type | Organization
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Legal Business Name | WICHITA FAMILY DENTAL LLC
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1445 N. RIDGE RD
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City | WICHTIA
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State | KS
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Zip | 67212
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Country | US
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Telephone | 316-773-1445
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Fax | 316-721-5557
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Provider Business Mailing Address
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Address Line | 1445 N RIDGE RD
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City | WICHITA
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State | KS
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Zip | 67212-2985
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Country | US
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Telephone | 316-773-1445
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Fax | 316-721-5557
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | STEPHANIE OXFORD
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Credential |
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Telephone | 316-773-1445
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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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