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WICHITA FAMILY DENTAL SOUTH LLC
NPI 1194365817
Clinic/Center - Dental in Derby, KS

Active since January 10, 2020CLIA 17D2170044 · Waiver
1120 N ROCK RD STE 100, DERBY, KS 67037(316) 630-9339 Get Directions Write a Review

NPPES record last updated: January 10, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Wichita Family Dental South Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WICHITA FAMILY DENTAL SOUTH LLC (NPI 1194365817) is a healthcare organization registered as a dental in Derby, Kansas and active in the NPI registry since January 2020. The organization holds a CLIA Waiver certificate valid through July 31, 2027 and lists Stephanie N Brandes, Clinical Director, as its authorized official.

NPPES Registry Identity

NPI1194365817
Entity TypeOrganization
Primary Taxonomy261QD0000X
Legal Business NameWICHITA FAMILY DENTAL SOUTH LLC
Location Address1120 N ROCK RD STE 100Derby, KS 67037-3587
Mailing Address9339 E 21st St NWichita, KS 67206-2971 · (316) 630-9339
Phone(316) 630-9339
Organization SubpartNo
Authorized OfficialStephanie N BrandesClinical Director · (316) 630-9339
Enumeration DateJanuary 10, 2020
✔ NPI 1194365817 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · DentalAmbulatory Health Care Facilities
Taxonomy Code261QD0000X
1120 N ROCK RD STE 100, Derby, KS 67037
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Other Names 2

Other NameDerby Dental Care
Other NameWichita Family Dental South

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Kansas, Inc..Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 17D2170044

Wichita Family Dental, LLC · Wichita, KS
Active · expires Jul 31, 2027
CLIA Number17D2170044
Laboratory TypePractitioner Other
Certificate Effective DateAugust 1, 2025
Certificate Expiration DateJuly 31, 2027
Laboratory DirectorCharles H. Pierson
Laboratory Phone(316) 630-9339
Laboratory LocationWichita Family Dental, LLC9339 East 21st Street North, Wichita, KS 67206
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CODY GUNNELL
Dentist
1120 N ROCK RD STE 100
DERBY, KS 67037
Sedgwick County (316) 789-9999
DERBY WFD GPS LLC
Clinic/Center (Dental)
1120 N ROCK RD STE 100
DERBY, KS 67037
Sedgwick County (316) 333-6446

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wichita Family Dental South LLC's NPI number?

The NPI number for Wichita Family Dental South LLC is 1194365817. It was assigned to this organization in the NPPES registry on January 10, 2020. The provider is also known as Derby Dental Care and Wichita Family Dental South.

Where is Wichita Family Dental South LLC located?

Wichita Family Dental South LLC is located at 1120 N Rock Rd Ste 100, Derby, KS 67037. The listed phone number is (316) 630-9339.

What is Wichita Family Dental South LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Dental, with taxonomy code 261QD0000X.

Does Wichita Family Dental South LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 17D2170044) is associated with this NPI, valid through July 31, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Wichita Family Dental South LLC accept?

Health plans from Blue Cross and Blue Shield of Kansas, Inc. list Wichita Family Dental South LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Wichita Family Dental South LLC was last updated on January 10, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.