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General NPI Number Information
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NPI Number | 1992387559
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Entity Type | Organization
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Legal Business Name | SMILES ORTHODONTICS LLC
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Dates
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Enumeration Date | 04/23/2021
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Last Update Date | 04/23/2021
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Provider Practice Location Address
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Address Line | 7015 E CENTRAL AVE
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City | WICHITA
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State | KS
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Zip | 67206-1943
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Country | US
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Telephone | 316-684-5184
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Fax | 316-684-5197
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Provider Business Mailing Address
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Address Line | 7015 E CENTRAL AVE
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City | WICHITA
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State | KS
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Zip | 67206-1943
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Country | US
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Telephone | 316-684-5184
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Fax | 316-684-5197
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Authorized Official
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Title or Position | ORTHODONTIST/PARTNER
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Name | SUMAN GORANTLA
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Credential | DMD
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Telephone | 316-684-5184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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