Provider Demographics
NPI:1699228379
Name:SENECA FAMILY DENTISTRY
Entity type:Organization
Organization Name:SENECA FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-522-4759
Mailing Address - Street 1:2860 S SENECA ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-2865
Mailing Address - Country:US
Mailing Address - Phone:316-522-4759
Mailing Address - Fax:316-522-3250
Practice Address - Street 1:2860 S SENECA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67217-2865
Practice Address - Country:US
Practice Address - Phone:316-522-4759
Practice Address - Fax:316-522-3250
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENECA FAMILY DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS609671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty