# WICHITA STATE UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WICHITA STATE UNIVERSITY
- **Other names:** Advanced Education in General Dentistry
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1336427582
- **Legal business name:** WICHITA STATE UNIVERSITY
- **Authorized official:** MRS. JO DENISE CLEPPER RN (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (316) 978-5662

## Contact information

- **Practice address:** 2838 N. OLIVER, WICHITA, KS 67220-0157
- **Practice address phone:** (316) 978-5662
- **Practice address fax:** (316) 978-3025
- **Mailing address:** 1845 FAIRMOUNT ST, BOX 157, WICHITA, KS 67260-0043
- **Mailing address phone:** (316) 978-5662
- **Mailing address fax:** (316) 978-3025

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | KS | Yes |

## Other

- **Enumeration date:** 07/21/2011
- **Last updated:** 07/21/2011