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General NPI Number Information
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NPI Number | 1811266042
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Entity Type | Organization
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Legal Business Name | CHILDREN'S DENTAL PROFESSIONALS
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Dates
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Enumeration Date | 12/16/2011
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 6943 W 37TH ST N
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City | WICHITA
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State | KS
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Zip | 67205-9302
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Country | US
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Telephone | 316-613-2077
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Fax | 316-613-2969
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Provider Business Mailing Address
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Address Line | 6943 W. 37TH STREET N.
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City | WICHITA
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State | KS
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Zip | 67205-9365
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Country | US
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Telephone | 316-613-2077
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Fax | 316-613-2969
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. MARIAH L FRAZIER
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Credential | DDS
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Telephone | 316-613-2077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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