Provider Demographics
NPI:1801330980
Name:SMILE CONNECTIONS FAMILY DENTAL, L.L.C.
Entity type:Organization
Organization Name:SMILE CONNECTIONS FAMILY DENTAL, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:VOLKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-722-8148
Mailing Address - Street 1:250 N TYLER RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3753
Mailing Address - Country:US
Mailing Address - Phone:316-722-8148
Mailing Address - Fax:316-773-0883
Practice Address - Street 1:250 N TYLER RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3753
Practice Address - Country:US
Practice Address - Phone:316-722-8148
Practice Address - Fax:316-773-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS602541223G0001X
KS71701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty