Provider Demographics
NPI:1184297178
Name:EBERSOLE, TRENTON LAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:TRENTON
Middle Name:LAYNE
Last Name:EBERSOLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 E QUIVIRA CT
Mailing Address - Street 2:
Mailing Address - City:KECHI
Mailing Address - State:KS
Mailing Address - Zip Code:67067-8909
Mailing Address - Country:US
Mailing Address - Phone:620-440-2948
Mailing Address - Fax:
Practice Address - Street 1:3151 N ROCK RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1312
Practice Address - Country:US
Practice Address - Phone:316-272-7876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS618141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice