Provider Demographics
NPI:1255309621
Name:ZIVNUSKA, PHILIP S (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:S
Last Name:ZIVNUSKA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 N WOODLAWN ST
Mailing Address - Street 2:SUITE 119
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-3957
Mailing Address - Country:US
Mailing Address - Phone:316-683-0411
Mailing Address - Fax:316-683-0204
Practice Address - Street 1:2424 N WOODLAWN ST
Practice Address - Street 2:SUITE 119
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-3957
Practice Address - Country:US
Practice Address - Phone:316-683-0411
Practice Address - Fax:316-683-0204
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS56771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice