Organization
WICHITA ORAL SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELIKA ROE (CREDENTIALING)
(888) 247-1869
Entity
Organization
Contact information
Practice address
12611 E 21ST ST N, WICHITA, KS 67206-3594
(316) 742-1506
(316) 742-1507
Mailing address
12611 E 21ST ST N, WICHITA, KS 67206-3594
(316) 742-1506
(316) 742-1507
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Enumeration date
06/06/2018
Last updated
06/06/2018
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