Healthcare Provider Details

I. General information

NPI: 1790485969
Provider Name (Legal Business Name): RYAN FURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10427 N MULBERRY ST
KANSAS CITY MO
64155-2748
US

IV. Provider business mailing address

10427 N MULBERRY ST
KANSAS CITY MO
64155-2748
US

V. Phone/Fax

Practice location:
  • Phone: 801-678-4948
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number2025045147
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: