Organization
TWIN LAKES DENTAL PA
Active
Other names
Adventure Dental and Vision
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUN URBANOZO (CREDENTIALING MANAGER)
(719) 323-2362
Entity
Organization
Contact information
Practice address
1901 W 21ST ST, WICHITA, KS 67203-2106
(316) 832-2838
(316) 832-9530
Mailing address
2221 E BIJOU ST STE 100, COLORADO SPRINGS, CO 80909-8009
(719) 955-8896
(719) 955-3470
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
60387
KS
1223G0001X
General Practice Dentistry
Primary
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200420170B
—
KS
05
—
200432580A
—
KS
01
—
60387
STATE OF KANSAS
KS
Enumeration date
05/24/2007
Last updated
09/09/2025
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