Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 5457 | KS |
NPI | 1326167990 |
---|---|
Provider Name | Roger Guy Nolte |
First Address | Wichita, KS 67203-2755 |
Second Address | Wichita, KS 67214-2810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |