DR. Jerad Chance Divine, D.D.S.

NPI #1841587250 in Wichita, Kansas

Provider Information

NPI Number: 1841587250
Entity Type: Individual
Name: DR. Jerad Chance Divine, D.D.S.
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist - Endodontics
Credential: D.D.S.
Enumeration Date: Jul 6, 2011
Last Updated: Dec 12, 2022

Practice Location

Address: 12219 E CENTRAL AVE
City: Wichita
State: Kansas
ZIP Code: 67206-2808
Phone: (316) 681-1099

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X
Dentist - Endodontics — Endodontics	1223E0200X	Primary

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