WICHITA FAMILY DENTAL SOUTH LLC (NPI# 1194365817) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194365817 |
| Entity Type | Organization |
| Organization Name | WICHITA FAMILY DENTAL SOUTH LLC |
| Practice Address |
1120 N Rock Rd Ste 100 Derby KS 67037-3587 |
| Mailing Address |
9339 E 21st St N Wichita KS 67206-2971 |
| Practice Telephone | 3166309339 |
| Mailing Telephone | 3166309339 |
| Enumeration Date | 2020-01-10 |
| Last Update Date | 2020-01-10 |
| Authorized Official Name | MRS. STEPHANIE N BRANDES (CLINICAL DIRECTOR) |
| Authorized Official Telephone | 3166309339 |
| Authorized Official Credential | RDH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Derby Dental Care | Other Name - Individual/Organization |
| Wichita Family Dental South | Other Name - Individual/Organization |
| Street Address |
1120 N ROCK RD STE 100 |
| City | DERBY |
| State | KS |
| Zip Code | 67037-3587 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063888246 | Cody Gunnell | Dentist | 1120 N Rock Rd Ste 100, Derby, KS 67037-3587 | 2015-08-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114409182 | Lori Renee Young | Counselor | 1144 N. Buckner, Derby, KS 67037 | 2018-09-05 |
| 1295227585 | James Todd Hawkins | Social Worker | 918 E Wedgewood Dr., Derby, KS 67037 | 2018-06-01 |
| 1518454842 | Rock Regional Hospital, LLC | General Acute Care Hospital | 3251 Rock Road, Derby, KS 67037 | 2018-04-23 |
| 1093161325 | Inspired Care LLC | In Home Supportive Care | 1400 E Warren Ave, Derby, KS 67037 | 2016-05-05 |
| 1083095970 | Emily O'dell | Family Medicine | 1640 E Tall Tree Rd, Derby, KS 67037 | 2015-06-16 |
| 1700264017 | Grant Snider Dds, LLC | Dentist | 2701 North Rock Road, Suite 600, Derby, KS 67037 | 2015-05-07 |
| 1629472691 | Anaidy Claudio | Social Worker | 265 W Village Lake Dr, Derby, KS 67037 | 2014-10-20 |
| 1396094470 | Derby Assisted Living, LLC | Assisted Living Facility | 719 N. Klein Circle, Derby, KS 67037 | 2012-09-05 |
| 1700104635 | Cynthia D Holcomb | Social Worker | 1721 E. Osage, Suite 300, Derby, KS 67037 | 2010-05-17 |
| 1295066215 | Traci Lynn Borland | Occupational Therapist | 731 Klein Circle, Derby, KS 67037 | 2010-01-15 |
| Find all providers in zip 67037 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588139463 | Brandon Vanasse Dmd Pllc | Clinic/Center | 296 Main Street, Derby, VT 05829 | 2018-10-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669071783 | David L. Foley D.d.s. Inc | Clinic/Center | 940 N Andover Rd, Andover, KS 67002-9787 | 2020-10-20 |
| 1629680368 | Alexander J. Clark Dds, LLC | Clinic/Center | 8340 Mission Rd Ste 118, Prairie Village, KS 66206-1362 | 2020-08-22 |
| 1225653959 | Moxley Family Dental, LLC | Clinic/Center | 15455 E 13th St N, Wichita, KS 67230-7572 | 2020-06-09 |
| 1760018576 | Senior Dental Care of Ms, LLC | Clinic/Center | 8500 W 110th St Ste 450, Overland Park, KS 66210-4029 | 2020-03-13 |
| 1962037523 | Beverly Moon Dmd LLC | Clinic/Center | 4601 W 109th St Ste 240, Overland Park, KS 66211-1323 | 2020-03-04 |
| 1518504976 | M&m Family Dentistry LLC | Clinic/Center | 9319 E Harry St Ste 126, Wichita, KS 67207-5070 | 2019-12-04 |
| 1811542640 | Medical Heights Dental Center, Pa | Clinic/Center | 100 W Ross Blvd Ste 2c, Dodge City, KS 67801-7217 | 2019-08-08 |
| 1508419938 | Custom Dental of Ottawa, Pa | Clinic/Center | 2030 S Princeton St, Ottawa, KS 66067 | 2019-07-24 |
| 1114588639 | Evolve Family Dentistry, LLC | Clinic/Center | 1133 College Ave Ste A103, Manhattan, KS 66502-2795 | 2019-06-25 |
| 1477112563 | Wamego Dental Professionals LLC | Clinic/Center | 1519 W Us Highway 24, Wamego, KS 66547-1322 | 2019-06-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.