Organization
ANDRE THIBAULT, DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDRE ALAN THIBAULT DDS (OWNER)
(316) 616-1310
Entity
Organization
Contact information
Practice address
3900 W CENTRAL AVE, SUITE 100, WICHITA, KS 67203-4928
(316) 616-1310
Mailing address
3900 W CENTRAL AVE, SUITE 100, WICHITA, KS 67203-4928
(316) 616-1310
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
6292
KS
Other
Enumeration date
06/21/2011
Last updated
06/21/2011
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