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10240 W 29th St N Ste 102 Wichita KS 67205-7914 | |
| (316) 252-3075 | |
| (316) 252-3080 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 10240 W 29th St N Ste 102, Wichita, Kansas |
| Authorized Official Name and Position | Brett T. Lyman (OWNER) |
| Authorized Official Contact | 3162523075 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 920050 Dallas TX 75392-0050 Ph: (714) 845-8500 | 10240 W 29th St N Ste 102 Wichita KS 67205-7914 Ph: (316) 252-3075 |
| NPI Number | 1972000420 |
|---|---|
| Provider Enumeration Date | 04/11/2018 |
| Last Update Date | 05/11/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972000420 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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