Healthcare Provider Details

I. General information

NPI: 1679659536
Provider Name (Legal Business Name): L G KANNING DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 EAST 6TH STR
LAWSON MO
64062-4826
US

IV. Provider business mailing address

201 EAST D HWY P.O.BOX 496
LAWSON MO
64062-4826
US

V. Phone/Fax

Practice location:
  • Phone: 816-296-3252
  • Fax: 816-296-3058
Mailing address:
  • Phone: 816-296-3252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number011458
License Number StateMO

VIII. Authorized Official

Name: DR. LARRY G. KANNING
Title or Position: PRESIDENT
Credential: DDS
Phone: 816-296-3252