Healthcare Provider Details

I. General information

NPI: 1396747440
Provider Name (Legal Business Name): GUY S DEYTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6416 N COSBY AVE
KANSAS CITY MO
64151-2377
US

IV. Provider business mailing address

6416 N COSBY AVE
KANSAS CITY MO
64151-2377
US

V. Phone/Fax

Practice location:
  • Phone: 816-587-6444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14126
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: