Individual
DR. MYLES DAVIDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3510 N RIDGE RD STE 500, WICHITA, KS 67205
(316) 722-0800
(316) 722-5822
Mailing address
3510 N RIDGE RD STE 500, WICHITA, KS 67205-1226
(316) 722-0800
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
6734
OK
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
61536
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61536
KANSAS DENTAL LICNESE
KS
01
—
6734
DENTAL LICENSE NUMBER
OK
Enumeration date
08/10/2015
Last updated
11/12/2019
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