Organization · Type 2 NPI

John R Provenzano Dds,pa

Oral and Maxillofacial Surgery (Dentist) · Wichita, KS

NPI number 1639449259 Active

Practice location

1515 S Clifton Ave Ste 120
Wichita, KS 67218-2951

Call (316) 681-3757 Map

Fax (316) 652-0602

Specialties and licenses

TaxonomyCodeLicense
Oral and Maxillofacial Surgery (Dentist) Primary 1223S0112X6557 (KS)

Oral and Maxillofacial Surgery (Dentist): 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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About NPI 1639449259

John R Provenzano Dds,pa's National Provider Identifier is 1639449259, issued on Jan 12, 2012. The primary taxonomy on file is Oral and Maxillofacial Surgery (Dentist) (1223S0112X), and the practice location is in Wichita, KS. The record was last updated on Feb 9, 2012.