Healthcare Provider Details

I. General information

NPI: 1215010764
Provider Name (Legal Business Name): DANIEL E KESSLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11863 STATE HWY 13 STE 20
KIMBERLING CITY MO
65686-0130
US

IV. Provider business mailing address

PO BOX 130
KIMBERLING CITY MO
65686-0130
US

V. Phone/Fax

Practice location:
  • Phone: 417-739-4965
  • Fax:
Mailing address:
  • Phone: 417-739-4965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14366
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: