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: 02/07/2019
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 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 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: DR. NELSON C KANNING
Title or Position: OWNER
Credential: DDS
Phone: 816-580-4191