Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 2589 | OH |
Y | 1223P0221X | Pediatric Dentist | 60502 | KS |
NPI | 1093911513 |
---|---|
Provider Name | Matthew Healy |
First Address | Wichita, KS 67230-7245 |
Second Address | Wichita, KS 67205-3039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 23/08/2018 |