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Search › Kansas › 1223E0200X

Jerad Divine, D.D.S

NPI 1841587250 · on the registry since 2011

Practice

Address
12219 E Central Ave
Wichita, KS 67206
Phone
(316) 681-1099
Fax
(316) 613-2417
Organisation at this address
Wichita Endodontics Llc
Inferred from a shared address, not stated in the registry.
Clinicians at this address
6

Registry record

Primary taxonomy
1223E0200X
1223E0200X
Also registered as
1223G0001X
Licence states on file
MO, KS
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2022-12-12

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Kansas