Organization
GABRIEL WURDEMAN
Active
Other names
Chautauqua Hills Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GERALDINE WILLIAMS (OFFICE MANAGER)
(620) 725-3122
Entity
Organization
Contact information
Practice address
120 W OSAGE ST, SEDAN, KS 67361-1518
(620) 725-3122
(620) 725-5395
Mailing address
120 W OSAGE ST, SEDAN, KS 67361-1518
(620) 725-3122
(620) 725-5395
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
60391
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200380810A
—
KS
Enumeration date
05/14/2007
Last updated
07/16/2008
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