Provider Demographics
NPI:1326564188
Name:WICHITA ENDODONTICS LLC
Entity Type:Organization
Organization Name:WICHITA ENDODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:HOFFMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-681-1099
Mailing Address - Street 1:12219 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2808
Mailing Address - Country:US
Mailing Address - Phone:316-681-1099
Mailing Address - Fax:316-613-2417
Practice Address - Street 1:12219 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2808
Practice Address - Country:US
Practice Address - Phone:316-681-1099
Practice Address - Fax:316-613-2417
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WICHITA ENDODONTICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-14
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS65451223E0200X
KS603981223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty