Healthcare Provider Details

I. General information

NPI: 1841367034
Provider Name (Legal Business Name): DANIEL JOSEPH DUELLO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 NE TUDOR RD
LEES SUMMIT MO
64086-5696
US

IV. Provider business mailing address

230 NE TUDOR RD
LEES SUMMIT MO
64086-5696
US

V. Phone/Fax

Practice location:
  • Phone: 816-524-4343
  • Fax: 816-524-2311
Mailing address:
  • Phone: 816-524-4343
  • Fax: 816-524-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE015295
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: