Provider Demographics
NPI:1346597069
Name:WICHITA FAMILY DENTAL PARTNERSHIP
Entity Type:Organization
Organization Name:WICHITA FAMILY DENTAL PARTNERSHIP
Other - Org Name:WICHITA FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:PIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-630-9339
Mailing Address - Street 1:9339 E 21ST ST N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2971
Mailing Address - Country:US
Mailing Address - Phone:316-630-9339
Mailing Address - Fax:316-630-9353
Practice Address - Street 1:9339 E 21ST ST N
Practice Address - Street 2:SUITE 200
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2971
Practice Address - Country:US
Practice Address - Phone:316-630-9339
Practice Address - Fax:316-630-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS59791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty