Provider Demographics
NPI:1215346713
Name:JONAS A. LICHTY DDS MD PA
Entity type:Organization
Organization Name:JONAS A. LICHTY DDS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:LICHTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MD
Authorized Official - Phone:316-634-1414
Mailing Address - Street 1:1919 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3405
Mailing Address - Country:US
Mailing Address - Phone:316-634-1414
Mailing Address - Fax:
Practice Address - Street 1:1919 N WEBB RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3405
Practice Address - Country:US
Practice Address - Phone:316-634-1414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1891965224Medicaid
1891965224OtherBCBS
KS420770002Medicare UPIN