DR. JERAD DIVINE, D.D.S.

Dentist - Endodontics

Active Individual
NPI: 1841587250

Practice Address

12219 E CENTRAL AVE
Wichita, KS 67206

Phone: (316) 681-1099

Specialties

Specialty Code Primary License
Dentist - General Practice 1223G0001X No 2011014424 (MO)
Dentist - Endodontics 1223E0200X Yes 61283 (KS)

Frequently Asked Questions

NPI 1841587250 is the National Provider Identifier for DR. JERAD DIVINE, D.D.S., a Dentist - Endodontics provider located in Wichita, KS. This NPI was enumerated on July 6, 2011.
DR. JERAD DIVINE, D.D.S. practices at 12219 E CENTRAL AVE, Wichita, KS 67206.

Quick Facts

NPI
1841587250
Type
Individual
Enumerated
Jul 6, 2011
Last Updated
Dec 12, 2022

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