Provider Demographics
NPI:1376320523
Name:WYCLIFF FAMILY DENTISTRY
Entity Type:Organization
Organization Name:WYCLIFF FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-722-0610
Mailing Address - Street 1:10400 W 103RD ST STE 21
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214-2664
Mailing Address - Country:US
Mailing Address - Phone:913-722-0610
Mailing Address - Fax:913-722-2893
Practice Address - Street 1:10400 W 103RD ST STE 21
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-2664
Practice Address - Country:US
Practice Address - Phone:913-722-0610
Practice Address - Fax:913-722-2893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental