Organization
SMALL SMILES OF WICHITA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENELL STUMP (DIRECTOR, LICENSING & CREDENTIALING)
(316) 686-2721
Entity
Organization
Contact information
Practice address
650 N CARRIAGE PKWY, SUITE #60, WICHITA, KS 67208-4507
(316) 686-2721
(316) 686-2744
Mailing address
650 N CARRIAGE PKWY, WICHITA, KS 67208-4507
(316) 686-2721
(316) 686-2744
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200383480A
—
KS
Enumeration date
02/26/2006
Last updated
03/26/2015
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