# ANDRE THIBAULT, DDS, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013203728
- **Authorized official:** DR. ANDRE ALAN THIBAULT DDS (OWNER)
- **Authorized official phone:** (316) 616-1310

## Contact information

- **Practice address:** 3900 W CENTRAL AVE, SUITE 100, WICHITA, KS 67203-4928
- **Practice address phone:** (316) 616-1310
- **Mailing address:** 3900 W CENTRAL AVE, SUITE 100, WICHITA, KS 67203-4928
- **Mailing address phone:** (316) 616-1310

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | 6292 | KS | Yes |

## Other

- **Enumeration date:** 06/21/2011
- **Last updated:** 06/21/2011