WICHITA FAMILY DENTAL SOUTH LLC
NPI 1194365817
Clinic/Center - Dental in Derby, KS
NPI Status: Active since January 10, 2020
Contact Information
1120 N ROCK RD STE 100
DERBY, KS
ZIP 67037
Phone: (316) 630-9339
- Organization
- Clinic/Center
- Dental
- Accepts Insurance
- CLIA Number: 17D2170044
- CLIA Cert. Type: Practitioner Other
- CLIA Exp. Date: 07-31-2027
About WICHITA FAMILY DENTAL SOUTH LLC
This page provides the complete NPI Profile along with additional information for Wichita Family Dental South Llc, a provider established in Derby, Kansas operating as a Clinic/center, focusing in dental . The healthcare provider is registered in the NPI registry with number 1194365817 assigned on January 2020. The practitioner's primary taxonomy code is 261QD0000X. The provider is registered as an organization and their NPI record was last updated 6 years ago. The authorized official of this NPI record is Mrs. Stephanie N Brandes Rdh (Clinical Director)
- NPI
- 1194365817
- Provider Name
- WICHITA FAMILY DENTAL SOUTH LLC
- Entity Type
- Organization
- Location Address
- 1120 N ROCK RD STE 100 DERBY, KS 67037
- Location Phone
- (316) 630-9339
- Mailing Address
- 9339 E 21ST ST N WICHITA, KS 67206
- Mailing Phone
- (316) 630-9339
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 01-10-2020
- Last Update Date
- 01-10-2020
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Dental
- Taxonomy Code
- 261QD0000X
- Type
- Ambulatory Health Care Facilities
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- BlueCare EPO Bronze - EPO
- BlueCare EPO Gold - EPO
- BlueCare EPO Gold Plus - EPO
- BlueCare EPO Silver Plus - EPO
- BlueCare EPO Simple Bronze HDHP - EPO
- BlueCare EPO Simple Silver HDHP - EPO
- BlueCare EPO Standardized Expanded Bronze - EPO
- BlueCare EPO Standardized Gold - EPO
- BlueCare EPO Standardized Silver - EPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 17D2170044
- Facility Type
- Practitioner Other
- Certificate Effective Date
- August 01, 2025
- Certificate Expiration Date
- July 31, 2027
- Laboratory Director
- CHARLES H. PIERSON
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Wichita Family Dental South Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1194365817, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 63. The final step is to find the difference between that total and the next multiple of ten (70 - 63 = 7).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 63 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 2 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1194365817, enumerated as an "organization" on January 10, 2020.
The provider is located at 1120 N ROCK RD STE 100 DERBY, KS 67037 and the phone number is (316) 630-9339.
Clinic/Center with taxonomy code 261QD0000X and a focus in Dental.
The provider might be accepting Accepts: Blue Cross and Blue Shield of Kansas, Inc.. Please consult your insurance carrier or call the provider to verify.
