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General NPI Number Information
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NPI Number | 1699727388
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Entity Type | Organization
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Legal Business Name | J. GREG HOLM D.D.S.,P.A.
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 7405 W CENTRAL AVE
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City | WICHITA
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State | KS
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Zip | 67212-3514
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Country | US
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Telephone | 316-722-3191
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Fax | 316-722-7824
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Provider Business Mailing Address
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Address Line | 7405 W CENTRAL AVE
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City | WICHITA
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State | KS
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Zip | 67212-3514
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Country | US
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Telephone | 316-722-3191
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Fax | 316-722-7824
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KIM A WEHMEYER
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Credential |
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Telephone | 316-722-3191
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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 | 6378
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License Number State | KS
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