Provider Demographics
NPI:1891819470
Name:FINE ART OF FAMILY DENTISTRY, PA
Entity Type:Organization
Organization Name:FINE ART OF FAMILY DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WUTHNOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-823-5568
Mailing Address - Street 1:1615 E IRON AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3237
Mailing Address - Country:US
Mailing Address - Phone:785-823-5568
Mailing Address - Fax:785-823-0477
Practice Address - Street 1:1615 E IRON AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3237
Practice Address - Country:US
Practice Address - Phone:785-823-5568
Practice Address - Fax:785-823-0477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6784122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty