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General NPI Number Information
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NPI Number | 1598108508
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Entity Type | Organization
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Legal Business Name | MY DENTIST WICHITA, DDS, PA
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Dates
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Enumeration Date | 04/09/2013
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Last Update Date | 12/16/2013
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Provider Practice Location Address
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Address Line | 1443 N ROCK RD
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City | WICHITA
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State | KS
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Zip | 67206-1245
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Country | US
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Telephone | 316-295-2830
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Fax | 316-295-2833
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Provider Business Mailing Address
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Address Line | PO BOX 702620
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City | TULSA
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State | OK
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Zip | 74170-2620
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Country | US
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Telephone | 405-286-9024
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Fax | 405-286-9088
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Authorized Official
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Title or Position | CHIEF DENTAL DIRECTOR
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Name | JENNIFER CHAMBERS
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Credential | DDS
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Telephone | 405-753-1237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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