# WITCHITA 21ST DENTAL, PA

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

## Provider details

- **NPI number:** 1639799307
- **Authorized official:** CREED L CARDON (DDS)
- **Authorized official phone:** (918) 998-0996

## Contact information

- **Practice address:** 10333 E 21ST ST N, WICHITA, KS 67206-3543
- **Practice address phone:** (316) 684-1470
- **Mailing address:** 400 RIVERWALK TER STE 250, JENKS, OK 74037-5619
- **Mailing address phone:** (918) 998-0996

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 261QD0000X | Dental Clinic/Center | — | — | — |

## Other

- **Enumeration date:** 04/22/2020
- **Last updated:** 05/29/2020