Provider Demographics
NPI:1407995236
Name:LANDRETH, ESTEL LEE (DDS)
Entity Type:Individual
Prefix:
First Name:ESTEL
Middle Name:LEE
Last Name:LANDRETH
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 1:4620 E DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3930
Mailing Address - Country:US
Mailing Address - Phone:316-685-9276
Mailing Address - Fax:316-685-2973
Practice Address - Street 1:4620 E DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3930
Practice Address - Country:US
Practice Address - Phone:316-685-9276
Practice Address - Fax:316-685-2973
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice