Healthcare Provider Details

I. General information

NPI: 1922405620
Provider Name (Legal Business Name): KANNING DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E 6TH ST
LAWSON MO
64062-7804
US

IV. Provider business mailing address

201 E 6TH ST
LAWSON MO
64062-7804
US

V. Phone/Fax

Practice location:
  • Phone: 816-580-4191
  • Fax: 816-296-3058
Mailing address:
  • Phone: 816-580-4191
  • Fax: 816-296-3058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2013016719
License Number StateMO

VIII. Authorized Official

Name: NELSON CARTER KANNING
Title or Position: OWNER/OPERATOR
Credential:
Phone: 816-580-4191