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JOHN R PROVENZANO DDS,PA
NPI 1639449259
Dentist - Oral and Maxillofacial Surgery in Wichita, KS

Active since January 12, 2012
1515 S CLIFTON AVE STE 120, WICHITA, KS 67218(316) 681-3757(316) 652-0602 Get Directions Write a Review

NPPES record last updated: February 9, 2012. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About John R Provenzano Dds,pa NPPES

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

JOHN R PROVENZANO DDS,PA (NPI 1639449259) is a healthcare organization registered as an oral and maxillofacial surgery in Wichita, Kansas and active in the NPI registry since January 2012. The organization lists John R Provenzano, Owner, as its authorized official.

NPPES Registry Identity

NPI1639449259
Entity TypeOrganization
Primary Taxonomy1223S0112X
Legal Business NameJOHN R PROVENZANO DDS,PA
Location Address1515 S CLIFTON AVE STE 120Wichita, KS 67218-2951
Mailing Address1515 S Clifton Ave Ste 120Wichita, KS 67218-2951 · (316) 681-3757 · Fax (316) 652-0602
Phone(316) 681-3757
Fax(316) 652-0602
Organization SubpartNo
Authorized OfficialJohn R ProvenzanoOwner · (316) 681-3757
Enumeration DateJanuary 12, 2012
Last NPPES UpdateFebruary 9, 2012
✔ NPI 1639449259 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License✔ Licensed in KS · 6557
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
1515 S CLIFTON AVE STE 120, Wichita, KS 67218
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Other Identifiers 1

Other019243KS · Medicare P-tan

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Home State Health, Ambetter from Sunflower Health Plan, Ambetter Health and more.Insurance ›

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 John R Provenzano Dds,pa's NPI number?

The NPI number for John R Provenzano Dds,pa is 1639449259. It was assigned to this organization in the NPPES registry on January 12, 2012.

Where is John R Provenzano Dds,pa located?

John R Provenzano Dds,pa is located at 1515 S Clifton Ave Ste 120, Wichita, KS 67218. The listed phone number is (316) 681-3757.

What is John R Provenzano Dds,pa's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

What insurance does John R Provenzano Dds,pa accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Home State Health, Ambetter from Sunflower Health Plan and Ambetter of Oklahoma and 2 other insurers list John R Provenzano Dds,pa 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 John R Provenzano Dds,pa was last updated on February 9, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.