Healthcare Provider Details

I. General information

NPI: 1427131531
Provider Name (Legal Business Name): JAMES MCKINNON MIXSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 LEES SUMMIT RD
KANSAS CITY MO
64139-1236
US

IV. Provider business mailing address

12711 GLENFIELD RD
LEAWOOD KS
66209-1728
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-6885
  • Fax: 816-404-6903
Mailing address:
  • Phone: 816-404-6885
  • Fax: 816-404-6903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13052
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5693
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: