Healthcare Provider Details

I. General information

NPI: 1265443279
Provider Name (Legal Business Name): MUKUKA KAPILIKISHA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1193 BRANSON HILLS PKWY
BRANSON MO
65616-9942
US

IV. Provider business mailing address

1193 BRANSON HILLS PKWY
BRANSON MO
65616-9942
US

V. Phone/Fax

Practice location:
  • Phone: 417-213-3025
  • Fax: 417-334-1614
Mailing address:
  • Phone: 417-213-3025
  • Fax: 417-334-1614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1223G0001X
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2020009238
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: