Healthcare Provider Details

I. General information

NPI: 1083540736
Provider Name (Legal Business Name): THE DENTAL STUDIO OF KENNETT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 TEACO RD
KENNETT MO
63857-3236
US

IV. Provider business mailing address

215 TEACO RD
KENNETT MO
63857-3236
US

V. Phone/Fax

Practice location:
  • Phone: 573-888-5936
  • Fax: 573-559-3006
Mailing address:
  • Phone: 573-888-5936
  • Fax: 573-559-3006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. PARASKEVI PANOUSIS
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 573-717-6161