# KENNETH W. NELSON, DDS, PA

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

## Provider details

- **NPI number:** 1013220813
- **Authorized official:** KENNETH W NELSON DDS (OWNER)
- **Authorized official phone:** (316) 634-1414

## Contact information

- **Practice address:** 1919 N. WEBB RD, WICHITA, KS 67206-3405
- **Practice address phone:** (316) 634-1414
- **Practice address fax:** (316) 634-2907
- **Mailing address:** 1919 N WEBB RD, WICHITA, KS 67206-3405
- **Mailing address phone:** (316) 634-1414
- **Mailing address fax:** (316) 634-2907

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 5149 | KS | Yes |

## Other

- **Enumeration date:** 07/21/2010
- **Last updated:** 07/21/2010