MEDICARE: DR. MICKEY LEE UNSELL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	015067	MO

General Provider Information

NPI Number	:	1891760880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICKEY LEE UNSELL DDS

Provider Business Mailing Address
First Line	:	1218 NE WINDSOR DR
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64086-5594
Country	:	US
Telephone Number	:	816-554-7668
Fax Number	:	816-554-7651

Provider Business Practice Location Address
First Line	:	1218 NE WINDSOR DR
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64086-5594
Country	:	US
Telephone Number	:	816-554-7668
Fax Number	:	816-554-7651

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	07/08/2007

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