Provider Demographics
NPI:1568981231
Name:WICHITA FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:WICHITA FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OXFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-773-1445
Mailing Address - Street 1:1445 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-2985
Mailing Address - Country:US
Mailing Address - Phone:316-773-1445
Mailing Address - Fax:316-721-5557
Practice Address - Street 1:1445 N. RIDGE RD
Practice Address - Street 2:
Practice Address - City:WICHTIA
Practice Address - State:KS
Practice Address - Zip Code:67212
Practice Address - Country:US
Practice Address - Phone:316-773-1445
Practice Address - Fax:316-721-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty