Organization
KIDSPACE PEDIATRIC DENTISTRY PARTNERSHIP
Active
Other names
Kidspace Pediatric Dentistry Partnership
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE LE (PRACTICE ADMINISTRATOR)
(316) 684-2100
Entity
Organization
Contact information
Practice address
430 N WOODLAWN ST, WICHITA, KS 67208-4300
(316) 684-2100
Mailing address
430 N WOODLAWN ST, WICHITA, KS 67208-4300
(316) 684-2100
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30004575080002
—
KS
05
—
30004579430004
—
KS
05
—
30004593990002
—
KS
Enumeration date
01/23/2023
Last updated
01/23/2023
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