Organization
BRAISDANALLC
Active
Other names
Behnaz Raisdana, DDS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BEHNAZ RAISDANA D.D.S. (OWNER DENTIST)
(316) 304-1582
Entity
Organization
Contact information
Practice address
13605 W MAPLE ST, SUITE 107 & 109, WICHITA, KS 67235-8759
(316) 304-1582
Mailing address
9509 E SHANNON WAY CIR, WICHITA, KS 67206-4042
(316) 304-1582
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
61092
KS
Other
Enumeration date
01/26/2015
Last updated
01/30/2015
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