Provider Demographics
NPI:1053763714
Name:TWIETMEYER, CHARLES (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:TWIETMEYER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 W 31ST ST S
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-1112
Mailing Address - Country:US
Mailing Address - Phone:316-942-3113
Mailing Address - Fax:
Practice Address - Street 1:3920 W 31ST ST S
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67217-1112
Practice Address - Country:US
Practice Address - Phone:316-942-3113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS612411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice