Healthcare Provider Details

I. General information

NPI: 1376341230
Provider Name (Legal Business Name): CAMERON DENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 N WALNUT ST
CAMERON MO
64429-8900
US

IV. Provider business mailing address

1720 N WALNUT ST
CAMERON MO
64429-8900
US

V. Phone/Fax

Practice location:
  • Phone: 816-632-6657
  • Fax: 816-632-5118
Mailing address:
  • Phone: 816-632-6657
  • Fax: 816-632-5118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KYONG-YUN KONG
Title or Position: DDS
Credential:
Phone: 816-632-6657