Individual
DR. BRENT WILLS CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
3659-12
MS
122300000X
Dentist
61218
KS
1223P0221X
Pediatric Dentistry
Primary
11892
TN
1223P0221X
Pediatric Dentistry
61218
KS
Other
Enumeration date
08/09/2012
Last updated
09/28/2023
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