Individual
DONALD J LUELLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3311 E MURDOCK ST, WICHITA, KS 67208-3054
(316) 689-9798
(316) 689-9417
Mailing address
PO BOX 8035, WICHITA, KS 67208-0035
(316) 689-9135
(316) 689-9102
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4772
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007923
BCBS
KS
01
—
12149376
MULTIPLAN
KS
Enumeration date
06/17/2006
Last updated
07/13/2007
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