Provider Demographics
NPI:1578308433
Name:DESCH, NICHOLAS JACOB (DDS)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JACOB
Last Name:DESCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10302 E 19TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1095
Mailing Address - Country:US
Mailing Address - Phone:785-817-0954
Mailing Address - Fax:
Practice Address - Street 1:2838 N OLIVER ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-2983
Practice Address - Country:US
Practice Address - Phone:316-978-8350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS62143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist