| NPI | 1013220813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH W NELSON Owner 316-634-1414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KS 5149) |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2010-07-21 |