Healthcare Provider Details

I. General information

NPI: 1306986872
Provider Name (Legal Business Name): MICHAEL DAVID MCCUNNIFF D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E 25TH ST
KANSAS CITY MO
64108-2716
US

IV. Provider business mailing address

650 E 25TH ST
KANSAS CITY MO
64108-2716
US

V. Phone/Fax

Practice location:
  • Phone: 816-235-2185
  • Fax: 816-235-5472
Mailing address:
  • Phone: 816-235-2185
  • Fax: 816-235-5472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number13893
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: