Provider Demographics
NPI:1790822633
Name:NORDHUS, BYRON J (DDS)
Entity type:Individual
Prefix:DR
First Name:BYRON
Middle Name:J
Last Name:NORDHUS
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 1:11940 W CENTRAL AVE STE 100
Mailing Address - Street 2:
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 STE 100
Practice Address - Street 2:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS71491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice