Healthcare Provider Details

I. General information

NPI: 1477992246
Provider Name (Legal Business Name): NELSON CARTER KANNING D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E 6TH ST
LAWSON MO
64062-7804
US

IV. Provider business mailing address

201 EAST 6TH STREET
LAWSON MO
64062
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 TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2013016719
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: