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General NPI Number Information
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NPI Number | 1891819470
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Entity Type | Organization
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Legal Business Name | FINE ART OF FAMILY DENTISTRY, PA
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1615 E IRON AVE
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City | SALINA
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State | KS
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Zip | 67401-3237
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Country | US
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Telephone | 785-823-5568
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Fax | 785-823-0477
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Provider Business Mailing Address
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Address Line | 1615 E IRON AVE
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City | SALINA
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State | KS
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Zip | 67401-3237
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Country | US
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Telephone | 785-823-5568
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Fax | 785-823-0477
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LYNN R WUTHNOW
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Credential | DDS
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Telephone | 785-823-5568
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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 | 6784
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License Number State | KS
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