JOHN R PROVENZANO DDS,PA (NPI# 1639449259) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639449259 |
| Entity Type | Organization |
| Organization Name | JOHN R PROVENZANO DDS,PA |
| Practice Address |
1515 S Clifton Ave Ste 120 Wichita KS 67218-2951 |
| Practice Telephone | 3166813757 |
| Practice Fax Number | 3166520602 |
| Mailing Telephone | 3166813757 |
| Mailing Fax Number | 3166520602 |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2012-02-09 |
| Authorized Official Name | JOHN R PROVENZANO (OWNER) |
| Authorized Official Telephone | 3166813757 |
| Authorized Official Credential | DDS,PA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
6557 | KS | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KS | MEDICARE P-TAN | 019243 | 01 |
| Street Address |
1515 S CLIFTON AVE STE 120 |
| City | WICHITA |
| State | KS |
| Zip Code | 67218-2951 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114544392 | Diana Ho | Optometrist | 980 Oliver Street, Wichita, KS 67218 | 2020-07-03 |
| 1134773690 | Lily Lopez | Nurse's Aide | 5107 E Kellogg Drive, Wichita, KS 67218 | 2019-08-01 |
| 1750862512 | Kelsi Wenger | Student in an Organized Health Care Education/Training Program | 5500 E Kellog Dr, Wichita, KS 67218 | 2018-08-28 |
| 1770038937 | Hair Replacement Clinic | Specialist | 1815 S Windsor, Wichita, KS 67218 | 2016-08-17 |
| 1457757346 | South Wind Women's Centter, LLC | Clinic/Center | 5701 E Kellogg Drive, Wichita, KS 67218 | 2014-11-05 |
| 1124460787 | Teri Kitchen | Social Worker | 3414 Kinkaid, Wichita, KS 67218 | 2013-07-24 |
| 1053660142 | Glenda Rodgers-lawless, Ph.d., Lcpc, Pa | Community/Behavioral Health | 4601 E Douglas, Wichita, KS 67218 | 2012-09-05 |
| 1649541848 | Stephen Rhinehart | Registered Nurse | 5500 E Kellogg Dr., Wichita, KS 67218 | 2012-01-19 |
| 1457666927 | Recovery Services Council Inc. | Point of Service | 1611 South Rutan, Wichita, KS 67218 | 2010-08-09 |
| 1043535867 | Melissa A Weinley | Respiratory Therapist, Registered | 5500 East Kellog Dr, Wichita, KS 67218 | 2010-04-05 |
| Find all providers in zip 67218 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013220813 | Kenneth W. Nelson, Dds, Pa | Dentist | 1919 N. Webb Rd, Wichita, KS 67206-3405 | 2010-07-21 |
| 1265530927 | W.r. Whitlow, D.d.s., Pa | Dentist | 1919 N Maize Rd Ste 200, Wichita, KS 67212-5203 | 2006-09-20 |
| 1427079979 | Roy E Cole | Dentist | 1919 N Webb Rd, Wichita, KS 67206-3405 | 2006-07-21 |
| 1619911641 | John D Gagnon | Dentist | 3510 N Ridge Rd, Ste 500, Wichita, KS 67205-1224 | 2006-06-16 |
| 1619461027 | Joseph R Tingey, Dds, Pa | Dentist | 3510 N Ridge Rd Ste 500, Wichita, KS 67205-1226 | 2018-06-19 |
| 1215346713 | Jonas A. Lichty Dds Md Pa | Dentist | 1919 N Webb Rd, Wichita, KS 67206-3405 | 2014-08-08 |
| 1275892671 | Matthew E Robertson Dmd LLC | Dentist | 3510 N Ridge Rd, Ste 500, Wichita, KS 67205-1224 | 2012-05-07 |
| 1942566476 | Joseph Ricks Tingey | Dentist | 3510 N Ridge Rd, Suite 500, Wichita, KS 67205-1224 | 2012-04-10 |
| 1679894356 | Roy E Cole Dds Md Pa | Dentist | 1919 N Webb Rd, Wichita, KS 67206-3405 | 2010-06-17 |
| 1497912356 | Remy H Blanchaert Jr Dds Md Pa | Dentist | 1919 N Webb Rd, Wichita, KS 67206-3405 | 2008-05-19 |
| Find all providers in WICHITA | ||||
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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.