Andrea Bodwell, RDH
Individual provider Active NPI Specialist · Wichita, KS
NPI 1861114654 · NPPES record last updated Jul 5, 2024
Key facts
- NPI
- 1861114654
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- Practice address
- 123 N Tyler Rd Ste 100
Wichita, KS 67212-3726 - Phone
- (316) 640-9049
- NPI assigned
- Sep 19, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 11111 | KS | MD | Dental Hygienist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 11111 | KS | |
| Specialist |
174400000X | Yes |
Addresses
Primary practice location
123 N Tyler Rd Ste 100
Wichita, KS 67212-3726
Mailing address
2926 N Wild Rose CT
Wichita, KS 67205-1638
Phone (316) 640-9049
Other practice location 1
2926 N Wild Rose Ct
Wichita, KS 67205-1638
Phone (316) 640-9049
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 Jul 5, 2024. 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.