Healthcare Provider Details

I. General information

NPI: 1316258395
Provider Name (Legal Business Name): MATTHEW D TINNEL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 LEES SUMMIT RD
KANSAS CITY MO
64139-1236
US

IV. Provider business mailing address

7900 LEES SUMMIT RD
KANSAS CITY MO
64139-1236
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-7000
  • Fax: 816-404-6903
Mailing address:
  • Phone: 816-404-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60671
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: