NPIMap

Organization Active NPI

Fetzik Dentistry LLC

  • Dentist
  • Wichita, KS
National Provider Identifier
1497002133
Registry record updated Aug 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
60099 Issued in KS
Legal business name
FETZIK DENTISTRY LLC
Practice address
2548 N Maize CT
Suite 100
Wichita, KS 67205-7347
Phone
(316) 440-4432
Fax
(316) 522-4766
NPI assigned
Aug 13, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2012

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

Authorized official

Name
Dr. Stephen P Fetzik, DMDNPI 1477549053
Title
Owner
Phone
(316) 440-4432

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 60099 KS Primary

Addresses

Primary practice location

2548 N Maize CT
Suite 100
Wichita, KS 67205-7347

Mailing address

2548 N Maize CT
Suite 100
Wichita, KS 67205-7347
Phone (316) 440-4432

National Provider Directory

National Provider Directory

Locations

2548 N Maize Ct
Ste 100
Wichita, KS 67205
Phone (316) 440-4432

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344816000000",
    "number": "1497002133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2548 N MAIZE CT",
            "address_2": "SUITE 100",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672057347",
            "telephone_number": "316-440-4432",
            "fax_number": "316-522-4766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2548 N MAIZE CT",
            "address_2": "SUITE 100",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672057347",
            "telephone_number": "316-440-4432",
            "fax_number": "316-522-4766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FETZIK DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-13",
        "last_updated": "2012-08-13",
        "status": "A",
        "authorized_official_last_name": "FETZIK",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "316-440-4432",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "KS",
            "license": "60099",
            "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 13, 2012; 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.