# MID-KANSAS ORAL & MAXILLOFACIAL SURGERY, LLC

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

## Provider details

- **NPI number:** 1881258366
- **Authorized official:** JOHN D GAGNON DDS (MEMBER)
- **Authorized official phone:** (316) 722-0800

## Contact information

- **Practice address:** 3510 N RIDGE RD STE 500, WICHITA, KS 67205-1226
- **Practice address phone:** (316) 722-0800
- **Practice address fax:** (316) 722-5822
- **Mailing address:** 3510 N RIDGE RD STE 500, WICHITA, KS 67205-1226
- **Mailing address phone:** (316) 722-0800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | Yes |

## Other

- **Enumeration date:** 04/30/2019
- **Last updated:** 11/12/2019