Organization
PARKLANE DENTAL PA
Active
Other names
Adventure Dental and Vision
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUN URBANOZO (CREDENTIALING MANAGER)
(719) 323-2362
Entity
Organization
Contact information
Practice address
980 S OLIVER ST, WICHITA, KS 97218-3216
(316) 221-3008
(316) 221-3015
Mailing address
2221 E BIJOU ST, STE 100, COLORADO SPRINGS, CO 80909-8009
(719) 955-8896
(719) 955-3470
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
61154
KS
1223G0001X
General Practice Dentistry
Primary
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61154
KANSAS DENTAL BOARD LICENSE NUMBER
KS
Enumeration date
01/04/2016
Last updated
09/09/2025
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