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

Dr. Jerad Chance Divine, DDS

Individual provider General Practice Dentistry · NPI 1841587250

Dr. Jerad Chance Divine, DDS is a General Practice Dentistry in Wichita, Kansas. Licensed in Kansas and Missouri. Registered with an NPI since 2011.

Licensed in
KS, MO
In the registry since
2011
Specialties on file
2
What do these letters mean?
DDS — Doctor of Dental Surgery
A dentist. DDS and DMD are the same qualification — universities choose which title to award.

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Practice location Address checks out

12219 E Central Ave
Wichita, KS 67206-2808
Phone: (316) 681-1099
Fax: (316) 613-2417
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Endodontics (primary) Taxonomy 1223E0200X · Licence 61283 (KS)
General Practice Dentistry Taxonomy 1223G0001X · Licence 2011014424 (MO)

Record details

NPI number1841587250
Entity typeIndividual (Type 1)
GenderMale
Credentials DDS
Sole proprietorNo
NPI enumeratedJuly 6, 2011
Last updated in NPPESDecember 12, 2022
Certification dateDecember 12, 2022
Mailing address12219 E Central Ave, Wichita, KS 67206-2808

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