NPIMap

Organization Active NPI

Wichita Pediatric Dentistry

  • Pediatric Dentistry
  • Wichita, KS
National Provider Identifier
1467507400
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
1223PO221X Issued in KS
Legal business name
WICHITA PEDIATRIC DENTISTRY
Practice address
1230 N Broadmoor Ave
#400
Wichita, KS 67206-3891
Phone
(361) 630-0090
Fax
(316) 630-0099
NPI assigned
Jan 23, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michael IsemanNPI 1578553285
Title
Doctor
Phone
(316) 630-0090

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 1223PO221X KS Primary

Addresses

Primary practice location

1230 N Broadmoor Ave
#400
Wichita, KS 67206-3891

Mailing address

1230 N Broadmoor Ave
#400
Wichita, KS 67206-3891
Phone (361) 630-0090

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467507400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1230 N BROADMOOR AVE",
            "address_2": "#400",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672063891",
            "telephone_number": "361-630-0090",
            "fax_number": "316-630-0099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 N BROADMOOR AVE",
            "address_2": "#400",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672063891",
            "telephone_number": "361-630-0090",
            "fax_number": "316-630-0099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICHITA PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ISEMAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "316-630-0090",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "KS",
            "license": "1223PO221X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.