| Wichita Family Dental South Llc | |
|
1120 N Rock Rd Ste 100 Derby KS 67037-3587 | |
| (316) 630-9339 | |
| Not Available |
| Full Name | Wichita Family Dental South Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1120 N Rock Rd Ste 100, Derby, Kansas |
| Authorized Official Name and Position | Stephanie N Brandes (CLINICAL DIRECTOR) |
| Authorized Official Contact | 3166309339 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wichita Family Dental South Llc 9339 E 21st St N Wichita KS 67206-2971 Ph: (316) 630-9339 | Wichita Family Dental South Llc 1120 N Rock Rd Ste 100 Derby KS 67037-3587 Ph: (316) 630-9339 |
| NPI Number | 1194365817 |
|---|---|
| Provider Enumeration Date | 01/10/2020 |
| Last Update Date | 01/10/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194365817 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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