Provider Demographics
NPI:1619474020
Name:VILLAGE DENTISTRY, PA
Entity Type:Organization
Organization Name:VILLAGE DENTISTRY, PA
Other - Org Name:VILLAGE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:
Authorized Official - Last Name:YIP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-252-3139
Mailing Address - Street 1:PO BOX 920050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0050
Mailing Address - Country:US
Mailing Address - Phone:316-252-3139
Mailing Address - Fax:316-252-3139
Practice Address - Street 1:2222 N. GREENWICH, SUITE 400
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226
Practice Address - Country:US
Practice Address - Phone:316-252-3139
Practice Address - Fax:316-252-3139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty