Provider Demographics
NPI:1770187452
Name:TWIETMEYER FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:TWIETMEYER FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:TWIETMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:316-942-3113
Mailing Address - Street 1:3920 W 31ST ST S
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-1112
Mailing Address - Country:US
Mailing Address - Phone:316-942-3113
Mailing Address - Fax:
Practice Address - Street 1:3920 W 31ST ST S
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67217-1112
Practice Address - Country:US
Practice Address - Phone:316-942-3113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental