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NPI Code Detail

MEDICARE: DR. MARY GRACE NORA D.M.D

MEDICARE: DR. MARY GRACE NORA D.M.D
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
11223G0001XGeneral Practice Dentistry61256KS

General Provider Information

NPI Number : 1942678370
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY GRACE NORA D.M.D
Provider Business Mailing Address
First Line : 2838 N OLIVER ST
Second Line :
City : WICHITA
State : KS
Zip : 67220-2983
Country : US
Telephone Number : 708-308-2824
Fax Number :
Provider Business Practice Location Address
First Line : 2838 N OLIVER ST
Second Line :
City : WICHITA
State : KS
Zip : 67220-2983
Country : US
Telephone Number : 708-308-2824
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2015
Last Update Date : 09/02/2015

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