Provider Demographics
NPI:1144921354
Name:ENVY DENTAL LLC
Entity type:Organization
Organization Name:ENVY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VESSALI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-214-5730
Mailing Address - Street 1:132 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-1246
Mailing Address - Country:US
Mailing Address - Phone:316-943-3273
Mailing Address - Fax:316-943-8491
Practice Address - Street 1:132 N WEST ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-1246
Practice Address - Country:US
Practice Address - Phone:316-943-3273
Practice Address - Fax:316-943-8491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty