| Kidspace Pediatric Dentistry Partnership | |
|
430 N Woodlawn St Wichita KS 67208-4300 | |
| (316) 684-2100 | |
| Not Available |
| Full Name | Kidspace Pediatric Dentistry Partnership |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 430 N Woodlawn St, Wichita, Kansas |
| Authorized Official Name and Position | Julie Le (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 3166842100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kidspace Pediatric Dentistry Partnership 430 N Woodlawn St Wichita KS 67208-4300 Ph: (316) 684-2100 | Kidspace Pediatric Dentistry Partnership 430 N Woodlawn St Wichita KS 67208-4300 Ph: (316) 684-2100 |
| NPI Number | 1407561590 |
|---|---|
| Provider Enumeration Date | 01/23/2023 |
| Last Update Date | 01/23/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407561590 | NPI | - | NPPES |
| 30004579430004 | Medicaid | KS | |
| 30004593990002 | Medicaid | KS | |
| 30004575080002 | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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