Provider Demographics
NPI:1225464019
Name:MARK W. SCHUYLER, DDS, LLC
Entity Type:Organization
Organization Name:MARK W. SCHUYLER, DDS, LLC
Other - Org Name:MARK W. SCHUYLER, DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCHUYLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-684-4921
Mailing Address - Street 1:12206 W 14TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-1203
Mailing Address - Country:US
Mailing Address - Phone:316-684-4921
Mailing Address - Fax:316-684-3076
Practice Address - Street 1:639 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-3001
Practice Address - Country:US
Practice Address - Phone:316-684-4921
Practice Address - Fax:316-684-3076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS58971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty