=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861840852
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BREANNA KRISTEN WILES D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2016
-----------------------------------------------------
Last Update Date | 09/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1537 E 17TH AVE
-----------------------------------------------------
City | HUTCHINSON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67501-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-238-6221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1537 E 17TH AVE
-----------------------------------------------------
City | HUTCHINSON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67501-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-238-6221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN15315
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 61141
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------