Individual
JOHN D GAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3510 N RIDGE RD, STE 500, WICHITA, KS 67205-1224
(316) 722-0800
(316) 722-5822
Mailing address
3510 N RIDGE RD, STE 500, WICHITA, KS 67205-1224
(316) 722-0800
(316) 722-5822
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
6850
KS
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
6850
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100317420A
—
KS
01
—
116677
BCBS OF KS
KS
01
—
974027
UNITED CONCORDIA
—
Enumeration date
06/16/2006
Last updated
11/12/2019
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