# WICHITA STATE UNIVERSITY

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

## Provider details

- **NPI number:** 1144495169
- **Authorized official:** DENISE MASEMAN (CHAIRPERSON)
- **Authorized official phone:** (316) 978-3614

## Contact information

- **Practice address:** 1845 FAIRMOUNT ST, WICHITA, KS 67260-9700
- **Practice address phone:** (316) 978-3614
- **Mailing address:** 12105 NANTUCKET ST, WICHITA, KS 67235-1224
- **Mailing address phone:** (316) 721-9885

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 5482 | KS | Yes |

## Other

- **Enumeration date:** 04/30/2008
- **Last updated:** 04/30/2008