Individual
DR. JOHN R PROVENZANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1515 S CLIFTON AVE, SUITE 120, WICHITA, KS 67218-2900
(316) 681-3757
(316) 652-0602
Mailing address
1515 S CLIFTON AVE, SUITE 120, WICHITA, KS 67218-2900
(316) 681-3757
(316) 652-0602
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
6557
KS
Other
Enumeration date
03/09/2006
Last updated
10/11/2011
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