# BRAISDANALLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Behnaz Raisdana, DDS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992195234
- **Authorized official:** DR. BEHNAZ RAISDANA D.D.S. (OWNER DENTIST)
- **Authorized official phone:** (316) 304-1582

## Contact information

- **Practice address:** 13605 W MAPLE ST, SUITE 107 & 109, WICHITA, KS 67235-8759
- **Practice address phone:** (316) 304-1582
- **Mailing address:** 9509 E SHANNON WAY CIR, WICHITA, KS 67206-4042
- **Mailing address phone:** (316) 304-1582

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 61092 | KS | Yes |

## Other

- **Enumeration date:** 01/26/2015
- **Last updated:** 01/30/2015