institution
John R Provenzano Dds,pa
Oral and Maxillofacial Surgery (Dentist) in Wichita, Kansas
NPI 1639449259

John R Provenzano Dds,pa is a Oral and Maxillofacial Surgery (Dentist) based in Wichita, KS and is specialized in Oral and Maxillofacial Surgery. John R Provenzano Dds,pa practices in Wichita, KS. The NPI Number for John R Provenzano Dds,pa is 1639449259 and holds a License No. 6557 (Kansas).

The current practice location address for John R Provenzano Dds,pa is 1515 S Clifton Ave Ste 120, Wichita, KS and can be reached out via phone at 316-681-3757 and via fax at 316-652-0602. You can also correspond with John R Provenzano Dds,pa through the mailing address at 1515 S CLIFTON AVE STE 120, WICHITA, KS - 67218-2951 (mailing address contact number: 316-681-3757).

Location: 1515 S Clifton Ave Ste 120, Wichita, KS, 67218-2951
institution
Provider Profile Details
NPI Number
1639449259
Provider Name
John R Provenzano Dds,pa
Credential
Provider Entity Type
Organization
Address
1515 S Clifton Ave Ste 120, Wichita, KS, 67218-2951
Phone Number
316-681-3757
Fax Number
316-652-0602
Provider Enumeration Date
01/12/2012
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
019243 01 KS MEDICARE P-TAN
institution
Provider Business Practice Location Address Details
Address
1515 S Clifton Ave Ste 120
City
State
Zip
67218-2951
Phone Number
316-681-3757
Fax Number
316-652-0602
person
Provider Business Mailing Address Details
Address
1515 S Clifton Ave Ste 120
City
State
Zip
67218-2951
Phone Number
316-681-3757
Fax Number
316-652-0602
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Oral and Maxillofacial Surgery
Taxonomy
License No.
6557 (Kansas)
Definition
The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
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