Mid-Kansas Oral & Maxillofacial Surgery, LLC

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

Legal business name

MID-KANSAS ORAL & MAXILLOFACIAL SURGERY, LLC

Practice address

3510 N Ridge Rd Ste 500
Wichita, KS 67205-1226

Phone

(316) 722-0800

Fax

(316) 722-5822

NPI assigned

Apr 30, 2019

Last updated

Nov 12, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John D Gagnon, DDSNPI 1619911641

Title

Member

Phone

(316) 722-0800

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• John D Gagnon, DDS

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Wichita, KS
  • NPI 1619911641
  Authorized official Same address or phone
• Raul Alvarez, DC

  • Chiropractor
  • Maize, KS
  • NPI 1811991409
  NPD

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

{
    "created_epoch": "1556582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573516800000",
    "number": "1881258366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3510 N RIDGE RD STE 500",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672051226",
            "telephone_number": "316-722-0800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3510 N RIDGE RD STE 500",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672051226",
            "telephone_number": "316-722-0800",
            "fax_number": "316-722-5822"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10111 E 21st St N Ste 107",
            "address_purpose": "LOCATION",
            "city": "Wichita",
            "state": "KS",
            "postal_code": "672063555",
            "country_code": "US",
            "telephone_number": "316-722-0800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MID-KANSAS ORAL & MAXILLOFACIAL SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-30",
        "last_updated": "2019-11-12",
        "status": "A",
        "authorized_official_last_name": "GAGNON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "316-722-0800",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral & Maxillofacial Surgery (D.M.D.) in Wichita, KS
• Providers in Wichita, KS by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2019; 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.