Organization
COTTONWOOD DENTAL KELLOGG, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE YATES (CFO)
(919) 998-0996
Entity
Organization
Contact information
Practice address
11333 E KELLOGG DR STE 900, WICHITA, KS 67207-1960
(918) 998-0996
Mailing address
400 RIVERWALK TER STE 250, JENKS, OK 74037-5619
(918) 998-0996
(918) 310-1056
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/26/2021
Last updated
03/26/2021
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