# J. GREG HOLM D.D.S.,P.A.

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

## Provider details

- **NPI number:** 1699727388
- **Authorized official:** KIM A WEHMEYER (OFFICE MANAGER)
- **Authorized official phone:** (316) 722-3191

## Contact information

- **Practice address:** 7405 W CENTRAL AVE, WICHITA, KS 67212-3514
- **Practice address phone:** (316) 722-3191
- **Practice address fax:** (316) 722-7824
- **Mailing address:** 7405 W CENTRAL AVE, WICHITA, KS 67212-3514
- **Mailing address phone:** (316) 722-3191
- **Mailing address fax:** (316) 722-7824

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 6378 | KS | Yes |

## Other

- **Enumeration date:** 05/17/2006
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 116941 | BC PROVIDER NUMBER | KS |
| 01 | — | 116942 | DR. GUST BC NUMBER | KS |
| 01 | — | 1336128990 | DR. GUST IND NPI NUMBER | KS |
| 01 | — | 1467451633 | INDIVIDUAL NPI NUMBER | KS |
| 01 | — | 421771 | GROUP BC NUMBER | KS |
| 01 | — | 60340 | DR GUST LIC NUMBER | KS |
| 01 | — | 6378 | DENTAL LIC NUMBER | KS |