MEDICARE: DR. PHILIP S ZIVNUSKA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5677	KS

General Provider Information

NPI Number	:	1255309621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP S ZIVNUSKA D.D.S.

Provider Business Mailing Address
First Line	:	2424 N WOODLAWN ST
Second Line	:	SUITE 119
City	:	WICHITA
State	:	KS
Zip	:	67220-3957
Country	:	US
Telephone Number	:	316-683-0411
Fax Number	:	316-683-0204

Provider Business Practice Location Address
First Line	:	2424 N WOODLAWN ST
Second Line	:	SUITE 119
City	:	WICHITA
State	:	KS
Zip	:	67220-3957
Country	:	US
Telephone Number	:	316-683-0411
Fax Number	:	316-683-0204

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	07/08/2007

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