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Organization
JOHN R PROVENZANO DDS,PA
Active
Organization
JOHN R PROVENZANO DDS,PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R PROVENZANO DDS,PA (OWNER)
(316) 681-3757
Entity
Organization
Contact information
Practice address
1515 S CLIFTON AVE STE 120, WICHITA, KS 67218-2951
(316) 681-3757
(316) 652-0602
Mailing address
1515 S CLIFTON AVE STE 120, WICHITA, KS 67218-2951
(316) 681-3757
(316) 652-0602
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
6557
KS
Other
Enumeration date
01/12/2012
Last updated
02/09/2012
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