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

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, DDS

Title

Member

Phone

(316) 722-0800

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• 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.