Witchita 21St Dental, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

WITCHITA 21ST DENTAL, PA

Practice address

10333 E 21St St N
Wichita, KS 67206-3543

Phone

(316) 684-1470

NPI assigned

Apr 22, 2020

Organization subpart

No

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

Authorized official

Name

Creed L Cardon

Title

DDS

Phone

(918) 998-0996

Specialties & licenses 2

Addresses

Practitioners 1

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

• Adam Richards, DMD

  • General Practice Dentistry
  • Marion, KS
  • NPI 1003553603
  NPD (past)

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

{
    "created_epoch": "1587513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590710400000",
    "number": "1639799307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 RIVERWALK TER STE 250",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740375619",
            "telephone_number": "918-998-0996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10333 E 21ST ST N",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672063543",
            "telephone_number": "316-684-1470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WITCHITA 21ST DENTAL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-22",
        "last_updated": "2020-05-29",
        "certification_date": "2020-05-29",
        "status": "A",
        "authorized_official_last_name": "CARDON",
        "authorized_official_first_name": "CREED",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DDS",
        "authorized_official_telephone_number": "918-998-0996"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Ann Wise
• Heather Wise
• Cayle Landon Wisinger
• Natalie Wissman, PHARMD
• Shirley L Witchey, RN, ARNP
• Richard G With, MS, LMFT
• Kylie Kristine Witham, PA-C
• Rhonda L Witherspoon, SLP
• Sean C Witherspoon
• Shea Witherspoon, LSCSW

• General Practice Dentistry in Wichita, KS
• Providers in Wichita, KS by specialty
• General Practice Dentistry in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 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.