=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760496061
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | S. AMIRANI DDS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1431 BLUFFVIEW ST STE 212
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67218-3039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-686-7155
-----------------------------------------------------
Fax | 316-686-4209
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1431 BLUFFVIEW ST STE 212
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67218-3039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-686-7155
-----------------------------------------------------
Fax | 316-686-4209
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/ DENTIST
-----------------------------------------------------
Name | DR. SAM S AMIRANI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 316-686-7155
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 7063
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------