Provider Demographics
NPI:1518504976
Name:M&M FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:M&M FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBBA-WORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-683-7081
Mailing Address - Street 1:144 N LONGFORD LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2427
Mailing Address - Country:US
Mailing Address - Phone:316-652-8869
Mailing Address - Fax:
Practice Address - Street 1:9319 E HARRY ST STE 126
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5070
Practice Address - Country:US
Practice Address - Phone:316-683-7081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental