Divine, Jerad Chance

Divine, Jerad Chance is an individual health care provider with primary practice located at 12219 E Central Ave , Wichita KS 67206-2808. He recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Endodontics. Dental Providers / Endodontics is his primary health care specialty. Divine, Jerad Chance can be contacted via phone (316) 681-1099.

Contact Information

Primary practice address
12219 E Central Ave Wichita KS 67206-2808
Phone: (316) 681-1099
Fax: (316) 613-2417
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 2011014424 Missouri
Dental Providers / Endodontics 1223E0200X 61283 Kansas

Profile Details

NPI number 1841587250
LBN Legal business name Divine, Jerad Chance
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 6th, 2011
Last updated Dec 12th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1841587250 NPPES
Missouri Other 2011014424 DENTAL LICENSE

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