Individual
KEVIN T. PETRIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3455 W 13TH ST N, WICHITA, KS 67203-4500
(316) 945-0543
Mailing address
12126 W HUNTERSVIEW ST, WICHITA, KS 67235-1220
(316) 721-6989
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5763
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10022250A
—
KS
01
—
7849
BCBS ID
KS
Enumeration date
09/13/2006
Last updated
07/09/2007
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