Individual
DAVID WILLARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10333 E 21ST ST N STE 101, WICHITA, KS 67206-3544
(316) 684-1470
(316) 684-1470
Mailing address
10333 E 21ST ST N STE 101, WICHITA, KS 67206-3544
(316) 684-1470
(316) 684-1470
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
61577
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200540820B
—
OK
Enumeration date
04/26/2018
Last updated
05/08/2024
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