Provider Demographics
NPI:1851937650
Name:PRECISION DENTAL WEST, LLC
Entity Type:Organization
Organization Name:PRECISION DENTAL WEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGROOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-558-3993
Mailing Address - Street 1:3900 W CENTRAL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4928
Mailing Address - Country:US
Mailing Address - Phone:316-558-3993
Mailing Address - Fax:316-558-3995
Practice Address - Street 1:3900 W CENTRAL AVE STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4928
Practice Address - Country:US
Practice Address - Phone:316-558-3993
Practice Address - Fax:316-558-3995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty