Organization
WITCHITA 21ST DENTAL, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CREED L CARDON (DDS)
(918) 998-0996
Entity
Organization
Contact information
Practice address
10333 E 21ST ST N, WICHITA, KS 67206-3543
(316) 684-1470
Mailing address
400 RIVERWALK TER STE 250, JENKS, OK 74037-5619
(918) 998-0996
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
04/22/2020
Last updated
05/29/2020
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