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General NPI Number Information
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NPI Number | 1780721134
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Entity Type | Organization
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Legal Business Name | ANTOINE E WAKIM DDS PA
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 710 N WOODCHUCK ST
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City | WICHITA
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State | KS
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Zip | 67212-3628
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Country | US
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Telephone | 316-721-4477
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Fax | 316-721-4099
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Provider Business Mailing Address
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Address Line | 710 N WOODCHUCK ST
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City | WICHITA
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State | KS
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Zip | 67212-3628
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Country | US
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Telephone | 316-721-4477
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Fax | 316-721-4099
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. ANTOINE EMILE WAKIM
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Credential | DDS
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Telephone | 316-721-4477
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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 | 6078
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License Number State | KS
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