Provider Demographics
NPI:1871626879
Name:NORDHUS FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:NORDHUS FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:J
Authorized Official - Last Name:NORDHUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-721-6730
Mailing Address - Street 1:11940 W CENTRAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-5180
Mailing Address - Country:US
Mailing Address - Phone:316-721-6730
Mailing Address - Fax:316-722-2736
Practice Address - Street 1:11940 W CENTRAL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-5180
Practice Address - Country:US
Practice Address - Phone:316-721-6730
Practice Address - Fax:316-722-2736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS71491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty