Provider Demographics
NPI:1184773541
Name:CAMBRIDGE FAMILY DENTISTY PA
Entity type:Organization
Organization Name:CAMBRIDGE FAMILY DENTISTY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-687-2110
Mailing Address - Street 1:2020 N WEBB RD
Mailing Address - Street 2:BLDG 301
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206
Mailing Address - Country:US
Mailing Address - Phone:316-687-2110
Mailing Address - Fax:316-636-9539
Practice Address - Street 1:2020 N WEBB RD
Practice Address - Street 2:BLDG 301
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206
Practice Address - Country:US
Practice Address - Phone:316-687-2110
Practice Address - Fax:316-636-9539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS420722OtherBLUE CROSS BLUE SHIELD