Jaclyn Blyholder, D.M.D.
Individual provider Active NPI Dentist · Wichita, KS
NPI 1780139659 · NPPES record last updated Aug 22, 2016
Key facts
- NPI
- 1780139659
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 61247 (KS)
- Practice address
- 639 S. Hillside
Wichita, KS 67211 - Phone
- (316) 684-4921
- NPI assigned
- Aug 22, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61247 | KS | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mark W. Schuyler, DDS, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 61247 | KS | Yes |
Addresses
Primary practice location
639 S. Hillside
Wichita, KS 67211
Mailing address
639 S. Hillside
Wichita, KS 67211
Phone (316) 684-4921
Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.