Organization
J. GREG HOLM D.D.S.,P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM A WEHMEYER (OFFICE MANAGER)
(316) 722-3191
Entity
Organization
Contact information
Practice address
7405 W CENTRAL AVE, WICHITA, KS 67212-3514
(316) 722-3191
(316) 722-7824
Mailing address
7405 W CENTRAL AVE, WICHITA, KS 67212-3514
(316) 722-3191
(316) 722-7824
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6378
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116941
BC PROVIDER NUMBER
KS
01
—
116942
DR. GUST BC NUMBER
KS
01
—
1336128990
DR. GUST IND NPI NUMBER
KS
01
—
1467451633
INDIVIDUAL NPI NUMBER
KS
01
—
421771
GROUP BC NUMBER
KS
01
—
60340
DR GUST LIC NUMBER
KS
01
—
6378
DENTAL LIC NUMBER
KS
Enumeration date
05/17/2006
Last updated
03/07/2023
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