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Organization
MID-KANSAS ORAL & MAXILLOFACIAL SURGERY, LLC
Active
Organization
MID-KANSAS ORAL & MAXILLOFACIAL SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D GAGNON DDS (MEMBER)
(316) 722-0800
Entity
Organization
Contact information
Practice address
3510 N RIDGE RD STE 500, WICHITA, KS 67205-1226
(316) 722-0800
(316) 722-5822
Mailing address
3510 N RIDGE RD STE 500, WICHITA, KS 67205-1226
(316) 722-0800
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
NULL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
04/30/2019
Last updated
11/12/2019
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