| Adventure Dental And Vision | |
|
1901 W 21st St Wichita KS 67203-2106 | |
| (316) 832-2838 | |
| (316) 832-9530 |
| Full Name | Adventure Dental And Vision |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1901 W 21st St, Wichita, Kansas |
| Authorized Official Name and Position | Shaun Urbanozo (CREDENTIALING MANAGER) |
| Authorized Official Contact | 7193232362 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Adventure Dental And Vision 2221 E Bijou St Ste 100 Colorado Springs CO 80909-8009 Ph: (719) 955-8896 | Adventure Dental And Vision 1901 W 21st St Wichita KS 67203-2106 Ph: (316) 832-2838 |
| NPI Number | 1003027749 |
|---|---|
| Provider Enumeration Date | 05/24/2007 |
| Last Update Date | 10/22/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003027749 | NPI | - | NPPES |
| 200420170B | Medicaid | KS | |
| 200432580A | Medicaid | KS | |
| 60387 | Other | KS | STATE OF KANSAS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (Kansas) | Primary |
| 1223G0001X | Dentist - General Practice | 60387 (Kansas) | Secondary |
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