Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

John R Provenzano DDS, PA

Organization Oral and Maxillofacial Surgery (Dentist) · NPI 1639449259

John R Provenzano DDS, PA is an Oral and Maxillofacial Surgery (Dentist) in Wichita, Kansas. Licensed in Kansas. Registered with an NPI since 2012.

Licensed in
KS
In the registry since
2012
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1515 S Clifton Ave Ste 120
Wichita, KS 67218-2951
Phone: (316) 681-3757
Fax: (316) 652-0602
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Oral and Maxillofacial Surgery (Dentist) (primary) Taxonomy 1223S0112X · Licence 6557 (KS)

Record details

NPI number1639449259
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official John Provenzano — Owner · (316) 681-3757
NPI enumeratedJanuary 12, 2012
Last updated in NPPESFebruary 9, 2012
Mailing address1515 S Clifton Ave Ste 120, Wichita, KS 67218-2951

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