=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972323137
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEMDENTA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2024
-----------------------------------------------------
Last Update Date | 03/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8833 W MAPLE ST
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67209-1419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-722-7331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8833 W MAPLE ST
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67209-1419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-722-7331
-----------------------------------------------------
Fax | 316-722-7586
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER DENTIST
-----------------------------------------------------
Name | TIFFANY RENEE PINKSTON
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 316-722-7331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------